LAPORAN KASUS

ACS ec UAP

Pembimbing: Prof. Dr. T. Bahri Anwar Sp. JP (K)

Disediakan oleh:
SHALINA KAUR 060100313
V.SATHIAS SUNDARI 060100316
Penyakit jantung koroner
• adalah penyakit jantung yang
disebabkan oleh kelainan
pembuluh darah koroner.
• Salah satu penyebab
utamanya adalah
aterosklerosis koroner yaitu
proses penimbunan lemak dan
jaringan fibrin
• Ini menyebabkan gangguan
fungsi dan struktur pembuluh
darah
• Seterusnya mengakibatkan
berkurangnya aliran darah ke
miokard.
• Kadar kolestrol darah
yang tinggi
• Tekanan darah tinggi
• Merokok
• Obesitas
• Berkurangnya aktivitas
 Faktor resiko
TIDAK DAPAT DAPAT DIMODIFIKASI
DIMODIFIKASI

DYSLIPIDEMIA
USIA HIPERTENSI
MEROKOK
JENIS KELAMIN DM
OBESITAS
GENETIK ALKOHOL
KURANG OLAHRAGA
Pathofisiologi
Unstable NSTEMI STEMI
Angina
Occluding thrombus Complete thrombus
Non occlusive sufficient to cause occlusion
thrombus tissue damage & mild
myocardial necrosis ST elevations on
Non specific ECG or new LBBB
ECG ST depression +/-
T wave inversion on Elevated cardiac
Normal cardiac ECG enzymes
enzymes
Elevated cardiac More severe
enzymes symptoms
 Angina tidak stabil
• Definisi apabila dikeluhkan :
1. keluhan dengan angina masih baru dalam 2 bulan
dimana angina cukup berat dan frekuensi cukup sering
lebih dari 3 kali per hari.

2. pasien dengan angina yang makin bertambah berat,

sebelumnya angina stabil lalu serangan angina timbul
lebih sering dan lebih berat sakit dadanya sedangkan
faktor presipitasinya berkurang.

3. pasien dengan serangan angina pada waktu istirehat.

 Saat beraktivitas maupun beristirehat

onset

on
at i

tion
atio n
retroternal atau loc

radia
sedikit di kirinya

g ,radi
anamnesa aktivitas ,stres

vating
Agrevatin
fisik ataupun
emosional .
du

Tidak berkurang
rat

dengan aktifitas
i on

atau nitrate SL

n
> Dari 20 minit Conditio
tertindih/berat di dada, rasa
desakan yang kuat dari
dalam atau dari bawah
diafragma, diremas-remas ,
panas
 TIMI Risk Score
Predicts risk of death, new/recurrent MI, need for
urgent revascularization within 14 days
Diagnosis
Chest pain suggestive of ischemia

Immediate assessment within 10 Minutes

Initial labs Emergent History &
and tests care Physical
– 12 lead ECG – IV access – Establish
– Obtain initial – Cardiac diagnosis
cardiac enzymes monitoring – Read ECG
– Oxygen
– electrolytes, – Identify
lipids, bun/cr, – Aspirin complications
glucose – Nitrates
– Assess for
– CXR – morphine
reperfusion
 ECG assessment

ST Elevation or new LBBB

STEMI

ST Depression or dynamic
T wave inversions
NSTEMI

Non-specific ECG
Unstable Angina
Diagnosis lain •Blood tests: used to evaluate
shows kidney and thyroid function as well
as to check cholesterol levels and
i fi c

s
ies
ec

arterie
the presence of anemia.

er arter
sp

Coronary
•Chest X-ray: shows the size of

Coroner
Angiography

Coron
your heart and whether there is
Sit
es

fluid build up around the heart and

of

ngin
Narrowi lungs.
me
asu
•Echocardiogram: shows a graphic
res
outline of the heart’s movement
od

•Ejection fraction (EF): determines

blo

Stress
Test
how well your heart pumps with
each beat.
ar t
he
to

su
pp
ly
MANAGEMENT
• Goal of therapy :
- improvement of symptoms
- prevent rupture of plaque
- prevent growth of plaque
• Risk factor modification

RISK FACTORS MODIFICATION

SMOKING  CEASE / STOP
DM  CONTROL
HYPERTENSION  CONTROL
DYSLIPIDEMIA  LDL <100mg/dl
 HDL >35mg/dl
LACK OF EXERCISE  ROUTINE EXERCISE
OBESE  LOSE WEIGHT –
DIET, EXERCISE
ALCOHOL  LIMIT ONLY 2
GLASS/DAY
PENGOBATAN
 Tirah baring, Oksigen 2-4L/i, analgesik
opiat, anti iskemik dan anti trombotik.

 Anti iskemik termasuk nitrogliserin buccal, 

blocker, Ca Antagonis.

 Anti trombotik : aspirin, clopidogrel,

unfractionated heparin iv atau LMWH, dan
Glycoprotein IIb/IIIa inhibitor.

 Diet rendah garam

Invasive theraphies
Angioplasty Bypass surgery
Medication Checklist
after ACS
• Antiplatelet agent
– Aspirin* and/or Clopidorgrel

• Lipid lowering agent

– Statin

• Antihypertensive agent
– Beta blocker
– ACE-I/ARB
– Aldactone (as appropriate)
•Get regular medical checkups.
•Control your blood pressure.
•Check your cholesterol.
•Don’t smoke.
•Exercise regularly.
•Maintain a healthy weight.
•Eat a heart-healthy diet.
•Manage stress.