Download - STEMI Maisarah
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Presented By :
Nor Maisarah Bt Mohamed Shukri
Supervisor :dr. Pendrik Tandean, SpPD
Myocardial Infarctionwith ST segment Elevation
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PATIENT IDENTITY
Name : Mrs. M
No.MR : 475376
Age : 67 years old
Gender : FemaleDate of admittance : 1st Agst !"11
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IST!"Y TA#IN$
%hie& 'omp(aint: Chest pain
istory takin):
%hest pain is &e(t * hours +e&ore admitted to the
hospita(. Pain &e(t ei)hted on her (e&t 'hest duration
more than - minutes, penetrates to the +a'k o& the+ody and arms. Pain &ee(s su'h s/uee0in) sensation inthe 'hest. The pain appeared sudden(y a&ter sheprayed and doin) house 'ores. Pain do not improved+y rest.
Seatin) 123 , Dyspnea 123, %ou)h 143
Nausea 143, vomitin) 143
Epi)astri' pain 123
De&e'ation and urination is norma(
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PAST I55NESS IST!"Y
#istory of $eart disease %&'.
Family $istory of $eart disease %&'
Dia(etes mellits %&'
#y)ertension %&'
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Cardiac Examination :9ns)ection : 9cts 2ordis +asn
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5AB!"AT!"Y 7INDIN$S
Complete blood count
B,2:1".3 1"3*l
R,2: 3.C4 1"6*l
#G,: 1!.3 gr*dl#2@: 36."
-?@: !71 1"3*El
Electrolyte
odim:13C mmol*l-otassim : 3.7 mmol*l
2$loride: 1"1 mmol*l
Blood chemistry
F-G : 1!C mg*dl>rem : 36 mg*dl
2reatinine : ".C mg*dl
G@*G-@: 35 * 1 *dl
2$olesterol @otal : !6 mg*dl
#D?: 4! mg*dl
?D?: !" mg*dl
@g: 7! mg*dl
2: 65!
2&M, : 77
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INTE"P"ETATI!N
"hythm : Sinus
8"S rate : * +pm"e)u(arity : "e)u(ar
P" interva( : .- se'
A9is : "AD
Morpho(o)y
P ave : norma(
8"S 'omp(e9 : 8 aves patho(o)i' in (ead ;,-,
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Thora9 PhotoAP:
%ardiome)a(y@%TI .?>
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E%!%A"DI!$"APY
%!N%5SI!N :
E7 ?C
ipokineti' septa(
EA ;
Dys&un'tion disto(i' )rade I
susp %AD
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F!"#IN$ DIA$N!SIS
STEMI e9tensive anterior onsetG ? hours #i((ip I
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T"EATMENT
Bed rest!- -4= 5pmI7D Na%( .HC ; dpm7arsor+id > m) ;4;4; S5 1hen needed3
7arsor+id ; m) ;4;4;Aspi(et *m) (oadin) - ta+s 14;43%(opido)re( >m) (oadin) = ta+s 1;443%aptopri( ?,-> m) ;4;4;
A(pra0o(am ,> m) 44;5a9adin syr 44- %"anitidine ; amp;-IAri9tra -,> m)S%-=
Simvastatin - m) 44;
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DIS%SSI!NA'ute Myo'ardia( In&ar'tion
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DE7INITI!N
Myo'ardia( in&ar'tion 1MI3 is the rapiddeve(opment o& myo'ardia( ne'rosis'aused +y a 'riti'a( im+a(an'e +eteen
the o9y)en supp(y and demand o& themyo'ardium.
This usua((y resu(ts &rom p(a/ue ruptureith throm+us &ormation in a 'oronary
vesse(s, resu(tin) in an a'ute redu'tiono& +(ood supp(y to a portion o& themyo'ardium.
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PAT!PYSI!5!$Y
!''urs hen 'oronary +(oodJo de'reases a+rupt(y a&ter athrom+oti' o''(usion o& a'oronary artery previous(yaKe'ted +y atheros'(erosis.
In most 'ases, in&ar'tion o''urshen an atheros'(eroti' p(a/ueLssures, ruptures, or u('erates
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In a'ute 'oronary syndrome, a 'oronaryartery p(a/ue erodes or ruptures, (eadin) to
the &ormation o& a +(ood '(ot, hi'h +(o'ksthe +(ood Jo.
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An area o& 'ardia' mus'(e dama)e dueto a'ute o''(usion in a 'oronary artery
that de(ivers +(ood to that area
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"IS# 7A%T!"S
A)e G => years o(d
Ma(e )ender
Smokin)
yper'ho(estero(emia andhypertri)(y'eridemia,
Dia+etes me((itus
Poor(y 'ontro((ed hypertension7ami(y history
Sedentary (i&esty(e
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%5INI%A5 7EAT"ES
%hest pain, G
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Yes
Yes
Acute MyocardialInfarction
( Q-wave non-Qwave !
"STEMI
( "o ST-Segment
Elevation
MyocardialInfarction !
#nsta$le Angina
s of myocardial ischemia
T segmen elevation %
hemical cardiac mar'ers %
Dia)nose
ECG
Lab
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In STEMI patients the ST se)ment is e(evated@ inNSTEMI patients the ST se)ment is not e(evated,and instead other patterns are seen. The most'ommon 'hara'teristi's o& NSTEMI E%$s are STdepression and T inversion.
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hat are cardiac mar'ers%
%ardia' markers are proteins e9pressed 'ommon(y ore9'(usive(y +y myo'ardia( 'e((s and re(eased into the 'ir'u(atin)
+(ood upon 'e(( ne'rosis. They are knon as troponin I, troponin T, myo)(o+in and %#4MB . These 'ardia' markers p(ay anessentia( ro(e in the )(o+a( risk assessment and treatment o&patients presentin) ith an a'ute 'oronary syndrome 1A%S3.
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MANA$EMENT
Bed restDiet
!9y)en
Aspirin andor anti p(ate(et a)ent
4+(o'ker
Nitrates
Trom+o(iti'
A%E inhi+itors
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5!%A5ISATI!N o& MI
Anteroseptal ) *+-*, Etensive anterior ) *+-*. I and
a*/ Anterolateral ) *,-*. I anda*/
Anterior limited ) *0-*1
Inferior ) II III dan a*2 3igh /ateral ) I dan a*/
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%!MP5I%ATI!N o& MI• Based on #I55IP '(assiL'ation:
Classi4cation 5escription
#I55IP I No 'ra'k(es, no C o& (un) Le(d,(un) edema
#I55IP I %ardio)eni' sho'k
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%!N%5SI!N
Starts 3ealthy /ifestyle
%han)e eatin) ha+its
"e)u(ar e9er'ise
Stop smokin)
Avoid stress
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TAN# Y!