STEMI ANTEROSEPTAL ONSET < 12 HOURS KILLIP I

STEMI ANTERoseptalONSET < 6 HOURSKILLIP IIBy:Andi Mulawarman

Supervisordr. Abdul Hakim Alkatiri, Sp.JP, FIHA1Case reportSTEMI2PATIENTS IDENTITYName: Mr. SAge: 34 y.o.MR: 696854Admitted: January 14th 20153HISTORY TAKINGChief complaintChest pain on the left sidePresent illness historySuffered since 3 hours agoDescribed as compressed and radiating pain from left back to part of neck, consistent, worsening with activity and abate with resting, cold sweating, duration of pain > 30 minutesNo DOE, PND and orthopneaNo nausea and vomitting

4HISTORY TAKINGPast illness historyNo history of previous chest painHistory of Hypertension deniedHistory of Diabetes deniedFamily history of heart disease present biological motherHistory of smoking > 20 years consist of 2 packs/day

5PHYSICAL EXAMINATIONGeneral statusModerate illness/well nourished/ consciousVital statusBP: 110/80 mmHgHR: 78 x/minutesRR: 28 x/minutesT: 36.5 oC6PHYSICAL EXAMINATIONHead: anemic (-) icteric (-) Neck: JVP R+2 cmH2O, Lung:Inspection: symmetry left=rightPalpation : mass (-), no tendernessPercussion: sonor left=rightAuscultation : vesicular, ronchi on lung base bilateral, wheezing -/-

7PHYSICAL EXAMINATIONCor :Inspection: ictus cordis not visiblePalpation: ictus cordis not palpable, thrill (-)Percussion: Upper border 2nd ICS sinistraRight border 4th ICS linea parasternalis dextraLeft border 5th ICS linea axillaris anterior sinistraAuscultation: heart sound I/II pure, regular, murmur (-)

8PHYSICAL EXAMINATIONAbdomen:Inspection : flat, follows breath movementAuscultation: peristaltic (+), normalPalpation: liver and spleen not palpablePercussion: tympani

Extremities :Edema (-)

9LABORATORY FINDINGSLaboratorium testsResultsWBC15.9 x 103 /mm3HGB15.4 g/dlPLT309 x 103 /mm3CK107 U/LCK-MB17.9 U/LTroponin T< 0.1 U/LGOT/GPT 29/45 U/LGDS178 mg/dlUric acid5.8 mg/dlUreum22 mg/dlCreatinin08 mg/dlNa/K/Cl142/4.4/111 mmol/l10ELECTROCARDIOGRAPHY

Sinus rhytmHR: 125 bpmAxis: normoaxisPR-Interval: NormalP-Wave: NormalQRS Duration: 0,12 minuteST-segment:ST elevation on V1-V4 T-wave: Normal

ConclusionSinus rhytm normoaksis, ST elevation on V1-V4, (Anteroseptal infarction)11CHEST X-RAYResult :Cardiomegaly (CTI index : 0.61) with dilatation aorta

12DIAGNOSISST Elevation Myocardial Infarction (STEMI) Anterior, onset < 6 hours, Killip II13TREATMENTO2 4 lpm via nasal kanulIVFD NaCl 0,9% 500 cc/24 hrsStreptokinase 1.5 million unit in NaCl 0.9% 100 cc over 1 hrFurosemide 40 mg/12 hrs/ivAspilet loading dose 160 mg, maintenance 80mg/24 hrs/oralClopidogrel loading dose 300 mg, maintenance 75mg/24 hrs/oralFarsorbid 5 mg/8 hrs/sublingualSimvastatin 20 mg/24 hrs/oralLaxadine 10 cc/24 hrs/oralAlprazolam 0.5 mg/24 hrs/oral

14DiscussionSTEMI15INTRODUCTION

Acute coronary syndromes (ACS) is a term for situations where the blood supplied to the heart muscle is suddenly blocked.described as a group of conditions resulting from acute myocardial ischemia (insufficient blood flow to heart muscle) ranging from unstable angina (increasing, unpredictable chest pain) to myocardial infarction (heart attack). 16INTRODUCTION

17Non occlusive thrombus

Non specific ECG

Normal cardiac enzymes

Occluding thrombus sufficient to cause tissue damage & mild myocardial necrosis

ST depression +/- T wave inversion on ECG

Elevated cardiac enzymes

Complete thrombus occlusion

ST elevations on ECG or new LBBB

Elevated cardiac enzymes

More severe symptomsNSTEMIUAPSTEMI18Pathophysiology

19RISK FACTORS20WHO DIAGNOSTIC CRITERIA 21INFARCT LOCATION

22CARDIAC BIOMARKERSMARKERNORMAL VALUECKL (