Case Cardio Adaptasi

8/11/2019 Case Cardio Adaptasi

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NSTEMI (NON STELEVATION MYOCARDIAL

INFARCTION)By :

Ashari Mohpul C 111 08 31

Supervisor :Dr. dr. Idar Mappangara, Sp.PD., Sp.JP., FIHA.

Car!iolo"# D$par%&$'%

M$!ial Faul%# o *asa'u!!i' +'i,$rsi%#-01.


2/31

PATIENTS IDENTITY

Name : Mrs. KR

Gender : Female

Age : 45 years old RM : 624!"

#a$e o% Admission :Augus$

"2nd& 2'"4


3/31

History Taking()ie% (omplain$:Ch$s% pai'

Guided Anamnesis: Symptoms !"t sin#! $ %o&rs '!or! admitt!d to %ospita".

Symptoms (as trigg!r!d 'y a#ti)ity, it (as !"t "ik! %!a)y

pr!ss!d at !pigastri# ar!a and it radiat!d to t%! "!t arm.

T%! d&ration (as *+ min. it (asnt r!"i!)!d 'y

#ons&ming ISDN -mgS/ and r!st. It &s&a""y

a##ompani!d 'y #o"d s(!ating. History o #%!st pain

'!or! 012 a'o&t 3 y!ar ago and in %ospita"i4!d. History in

angiograp%y and ad)is!d to #oronary st!nt. 5!g&"ar

m!di#a" tr!atm!nt %istory 012. So6 072, %istory o So6 '!or!072, DoE 072, PND 072,

ort%opn!a 072

History o HT 072, DM 072

8igar!tt! Smooking 072


4/31

Past I""n!ss History

*is%or# o h#p$r%$'sio' (/) *is%or# o !#slipi!$&ia ()

*is%or# o DM is !$'i$!

*is%or# o s&oi'" () Fa&il# his%or# o ar!io,asular

!is$as$ ()

*is%or# o h$s% pai' (/)2 1 #$ar a"o2

r$li$,$! i%h r$s% a'! o'su&i'" ISDN4&"5SL 6


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5isk Fa#tors

Ris* Fa+$ors :F$&al$ .4 #$ars ol!

*is%or# o h$s% pai' 1 #$ar a"o

*is%or# o h#p$r%$'sio'


6/31

8"ini#a" E:amination

G,N,RA- SA,Mo!$ra%$ ill'$ss5(!""7no&ris%!d5o'sious

/0A- S0GN

7 7loo! pr$ssur$ 130580 &&*"

7 9uls$ 110 %i&$s5&i'

7 7r$a%hi'" 18 %i&$s5&i'

7 T$&p$ra%ur$ 3:240C (A;illa)


7/31

1ead ,amina$ion E#$s a'$&i 52 i%$rus 52 o$!$&a

palp$


8/31

(ardia+ ,amina$ion I'sp$%io' IC is 'o% ,isi


9/31

A3dominal ,amina$ion

I'sp$%io' Fla% a'! ollos


10/31

E/E8T5;8A5DI;


11/31

INTE5P5ETATI;N R)y$)m : sinus r)y$m

RS ra$e : 1R 5 3pm ave : '.'7 se+

R in$erval : '."6 se+

RS +omple : '.'7 se+

Ais : Normoais

S segmen$ : S depression a$/!& /6

(on+lusion: Sinus r)y$)m& in%eriorand an$ero sep$al 8M0& an$erola$eral all myo+ard is+)emi+


12/31

LABORATORY FINDINGS

TEST RES+LT NORMAL VAL+E@7C =,= : 3$ &/ .201020 ; 103 5l

R7C @,> : 3 9" .20:20 ; 10:5l

*7 3@,3mgd" 13201B20 "5!l*CT @,3 B .0204.20

DS 104 &"5!l 1.0 &"5!l

+r$u& $3 mgd" 1040 &"5!l

Cr$a%i'i' ,- mgd" M(123)F(121)&"5!l

9LT $+3 : 3$ &/ 140400 ; 103 5l


13/31

TEST RES+LT NORMAL VAL+E

C C 9/ L(10) 9 (1:B)

Tropo'i' T ,+ N$"a%i

SOT $+ mgd" 38 +5l

S9T -$mgd" .1 +5l

To%al Chol$s%$rol $@+ mgd" -00 &"5!l

*DL -3mgd" M(G44)F(G:4)

&"5!lLDL 3-=mgd" 130 &"5!l

T +=mgd" -00 &"5!l

+ri Ai! .63 &"5!l -2.42B &"5!l


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8%!st 75ay

Conclusion:

8ardiom!ga"y, 8TI ,--

Di"atatio !t !"ongatio

aorta!

CHEST !RAY "A


15/31

;5GIN< DIA


16/31

T5EATMENT;+ +7@ /PM )ia Nasa" 8an&"!IFD Na8" ,CB 3+ dpmNitrat! ISDNFasor'id 03mg##2 +mg%o&rSPAnti7p"at!"!t aggr!gation

Aspi"!t > mg 737

8"opidogr!" 0P"a)i:2 =- mg 377Anti7#oag&"ant Ari:tra +,-mg+@%rsS8Statin Sim)astatin +mg 07732H+ antagonis 5anitidin 3amp>amIAnti7an:i!ty A"pra4o"am .- mg 07732 p.r.n/a:ati)! /a:adyn! syr 77+8


17/31

DIS89SSI;N


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Coro'ar# Ar%$r# Dis$as$Sta'"! Angina P!#toris


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DEFINITION

An'in$ (&ctoris is a syndrom!

#%ara#t!ri4!d 'y #%!st pain r!s&"ting rom an

im'a"an#! '!t(!!n ;+s&pp"y K d!mand, andis most #ommon"y #a&s!d 'y t%! ina'i"ity o

at%!ros#"!roti# #oronary art!ri!s to p!r&s!

t%! %!art &nd!r #onditions o in#r!as!d

myo#ardia" ;+#ons&mption6


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CLASSIFICATION6as!d on 8ANADIAN 8A5DI;AS89/A5 S;8IETY

F9N8TI;NA/ 8/ASSIFI8ATI;N

8/ASS I No angina (it% ordinary a#ti)ity. Angina (it%

str!n&o&s, rapid or pro"ong!d !:!rtion.

8/ASS II S"ig%t "imitation o ordinary a#ti)ityL angina (%!n(a"king &p stairs 'risk"y, or (a"king on a #o"d or (indy day.

8/ASS III Mark!d "imitationL angina (%!n (a"king at

norma" pa#! &p "ig%t o stairs, or (a"king 37+ '"o#ks

distan#!.

8/ASS I Angina on minima" !:!rtion or at r!st.


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PATH;


22/31

Causes of Unstable Angina

Reduction in oxygen supply to myocardium Coronary artery narrowing from non-occlusive thrombus on a

disrupted atherosclerotic plaque

Dynamic obstruction by coronary vasospasm or vasoconstriction

Severe narrowing without thrombus or spasm

progressive atherosclerosis

Restenosis after Percutaneous coronary intervention

Arterial inflammation and infection

!ncreased myocardial oxygen demand in the presence of

fixed restricted oxygen supply "ever# tachycardia# thyrotoxicosis# anemia


23/31

5ISG FA8T;5

Mo!iHa


24/31

DIANOSIS


25/31

orking Diagnos!

I h i t


26/31

Isch&mic sym(toms

Pro"ong!d pain 0&s&a""y *+ mins2 #onstri#ting,

#r&s%ing, s&!!4ing

9s&a""y r!trost!rna" "o#ation, radiating to "!t #%!st, "!t

arm, #an '! !pigastri#

Dyspn!a Diap%or!sis

Pa"pitations

Na&s!a)omiting

Mi"d %!ada#%!


27/31

8"ini#a" Mani!station


28/31

DIAt%!dition, E"s!)i!r, +-


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29

9ns$a3le Angina

)erapeu$i+ Goals$reatment for unstable angina focuses on three

goals%

S%a


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MANA


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Case Cardio Adaptasi

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