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 (