Acute Coronary Syndrome - Dr Nahar SpJP
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dr. Nahar Taufik, Sp.JP(K)
ACUTE CORONARY SYNDROMERisk Stratification and Timing to Revascularizsation
Bagian Kardiologi dan Kedokteran Vaskuler FK – UGM Yogyakarta |KSM Jantung – Pusat Jantung RSUP DR Sardjito Yogyakarta
Simposium 7
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Thrombus Formation and ACS
UAP NQMI STE-MI
Plaque Disruption/Fissure/Erosion
Thrombus Formation
Non-ST-Segment
Elevation
Acute Coronary
Syndrome (NSTE-
ACS)
ST-Segment
Elevation
Acute
Coronary
Syndrome
(STE-ACS)
Old
Terminology:
New
Terminology: UAP
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Spectrum Of ACS
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009SelectSelectSelectSelectSelectSelectSelectSelect
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Laki-laki, 55 tahun
FR : Merokok, dislipidemia
13 jam Pasien mengeluh nyeri dada seperti ditekan benda
berat, tembus sampai punggung, disertai nyeri ulu hati,
mual dan muntah, lemes, seperti mau pingsan
TD : 120/80 mmHg RR : 20x/menit
Nadi : 90x/menit VAS : 9-10
Pemeriksaan fisik lain dalam batas normal
Case 1
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
• onset 13 Jam (>12 jam)
• masih angina / on going
ischemia
• ST elevasi
Reperfusi
KONDISI - A
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
• onset 13 Jam (>12 jam)
• masih angina / on going
ischemia
• ST elevasi ?
Reperfusi ?
KONDISI - B
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
• onset 13 Jam (>12 jam)
• masih angina / on going
ischemia
• ST elevasi
• Gangguan Konduksi /
AV-Blok
Reperfusi
KONDISI - C
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Primary PCIFibrinolitik
30 menit 90 menit
Reperfusi
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Case 2
Di PPK -1 atau PPK - 2
Perempuan, 75 th
FR : Menopause, Hipertensi
3 JSMRS os mengeluh tiba-tiba lemas setelah makan siang, dada terasa ditekan, menjalar ke rahang, durasi ± 10 menit, nyeri mereda dengan istirahat, keringat dingin (-), mual (-),
TD : 140/90 RR : 20x/menit
Nadi : 70x/menit VAS : 9-10
Pemeriksaan fisik lain dalam batas normal
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Hb : 14 mg/dl
AL : 17,200 /m
AT : 230,000 /mmk
Hamatocrite : 40%
Creatinin : 1,6 mg/dl
CK : 258
CKMB : 35
Trop I : 0.2
DIFF DIAGNOSIS :
1. UAP / ANGINA FIRST
ONSET ?
2. N-STEMI ?
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Simposium Kedokteran Nasional Clinical Updates 2015|14-15 Maret 2015|FK UGM 1983 & 2009
Diagnosis Akhir :
N – STEMI
Intermediate Risk
GRACE SCORE
1. Usia : 73
2. CHF : -
3. Riwayat AMI: -
4. HR : 9
5. Sistolik : 10
6. ST depresi : 11
7. Creatinin : 7
8. Card Enz : 15
9. N0 PCI : 14
SCORE : 139
Diagnosis :
N – STEMI
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Thank You