REPERFUSION INJURY

Disusun Oleh
Furqan Rachman, S. Ked
Dede Achmad Basofi, S. Ked
Siska, S. Ked
Adela Brilian, S. Ked
Christopher Firstnando, S. Ked
Angga Dominius, S. Ked

Pembimbing
Letkol CKM dr. Prihati Pujowaskito, Sp. JP (K), MMRS

KEPANITERAAN KLINIK SMF KARDIOLOGI

RUMAH SAKIT TK.II DUSTIRA CIMAHI
FAKULTAS KEDOKTERAN
UNIVERSITAS TANJUNGPURA
2018
INTRODUCTION
• CHD  leading cause of death worldwide
• WHO  7,254,00 deaths  12,8% of all deaths
• Effect of CHD usually attributable  ischemia-
reperfusion-injury (IRI)
• IRI  arises in patients presenting  acute ST-
segment elevation myocardial infarction (STEMI)
• The most effective therapy  timely and
effective myocardial reperfusion using 
thrombolytic therapy or Primary Percutaneous
Coronary Intervention (PPCI)
ANATOMY of CARDIAC VESSELS
 Coronary artery  Very
important  Distributed
oxygen and nutrition
 2 main artery  Left Main
Coronary Artery (LMCA) and
Right Coronary Artery (RCA)
LEFT MAIN CORONARY ARTERY
 Left Main Coronary Artery  passes
between the left atrium and the
pulmonary trunk to reach AV
groove
 Dividing into  Left Anterior
Descending (LAD) & Left
Circumflex Artery (LCX)
 Anterior surface  Septal
branches (supply the anterior two
thirds of the interventricular Anterior
septum View

 Anterior surface of the left Posterior

ventricle  Diagonal branch View

 Posterior surface  Circumflex

artery
 lateral and posterior LV  Obtuse
marginal branches
RIGHT ARTERY CORONARY
 RCA  Travels in the right AV
groove, passing posteriorly
between the right atrium and
ventricle
 Acute marginal branches 
supplies blood to the right
ventricle
 Posterior descending artery 
Distal RCA gives rise to the large
branch Anterior
View
Posterior
View
CORONARY VEINS
 Coronary veins  follow
distribution similar to the major
coronary arteries
 Return blood from myocardial
capillaries  right atrium
predominantly via coronary sinus
 The major veins  lie in the
epicardial fat, usually superficial
to their arterial counterparts
PERCUTANEOUS CORONARY
INTERVENTION

 PCI (Percutaneous  Opening up narrowing in

Coronary Intervention) coronary arteries 
 has increased using fine tubes
dramatically  one of (catheters  treated
the most commonly with stents (fine mesh
performed medical tubes
intervention
 2 Accesses for PCI
 Treatment procedure   Radialis Artery
unblocks narrowed
 Femoralis Artery
coronary arteries 
during or after a heart
attack
PERCUTANEOUS CORONARY
INTERVENTION INDICATIONS and CONTRA
 Clinical indications for PCI are :  Contraindications are :
 Acute ST-Elevation MI (STEMI)  Intolerence of chronic
 Non-ST-Elevation acute antiplatelet therapy
coronary syndrome (NSTE-  Arteries <1,5 mm in
ACS) diameter
 Stable angina  Diffusely diseased
 Asymptomatic or mildly saphenous vein grafts
symptomatic patient with
objective evidence of a
moderate-sized to large area
of viable myocardium or
moderate to severe ischemia
on noninvasive testing
PERCUTANEOUS CORONARY
INTERVENTION - COMPLICATION
 Death
 Miocard infarc
 Tamponade
 Infection
 Vascular complications
 Haematom

 Pseudoaneurysm

 Retroperitoneal haematom
 atheroembolsm
ISCHEMIC REPERFUSION INJURY
 Definition :
 The myocardium can tolerate brief
periods  up to 15 minutes
 Acute Myocard Infarc  leading
cause of death in the world
 Intervention  reperfusion wih PPCI
(Pimary Percutaneous Coronary
Intervention)  reperfusion can
cause dysfunction of cardiomyocyte
 ischemic reperfusion injury
 Reperfusion injury results 
myocardial stunning, microvascular,
endothelial injury
CALPAIN SYSTEM ACTIVATION
OXYDATIVE STRESS IN ISCHEMIC
REPERFUSION INJURY
 Hipoxia  ATP production
reducing  ion pump
imbalance  Natrium and
calcium overload inside the
cell
 Glikolysis anaerob 
Reducing Intracellular Ph
 ROS  inducing cell
dysfunction and provoke cell
death
REPERFUSION-INDUCED HYPOTENSION
 Reperfusion induced hypotension (RIH) 
reopening acute RCA oclusion  RCA proximal
lesion
 Left ventricular inferior wall  supplied by the RCA
 rich with the vagus nerve plexus  excitabilities
increased during reperfusion  Bezold Jarisch reflex
 Arrhytmias  more commonly occur when reopening
the RCA than LAD  cardiac output would be
impaired
 Acute myocard infarc  RCA acute occlusion  more
likely ti sweating and vomitting before PCI  risk for
hypovolemic shock after reperfusion
Thank You!