stemi maisarah

8/17/2019 STEMI Maisarah

1/28

Presented By :

Nor Maisarah Bt Mohamed Shukri

Supervisor :dr. Pendrik Tandean, SpPD

Myocardial Infarctionwith ST segment Elevation


2/28

PATIENT IDENTITY

Name : Mrs. M

No.MR : 475376

Age : 67 years old

Gender : FemaleDate of admittance : 1st Agst !"11


3/28

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(


4/28

PAST I55NESS IST!"Y

#istory of $eart disease %&'.

Family $istory of $eart disease %&'

Dia(etes mellits %&'

#y)ertension %&'


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6/28

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 ;,-,


10/28

Thora9 PhotoAP:

%ardiome)a(y@%TI .?>


11/28

E%!%A"DI!$"APY

%!N%5SI!N :

E7 ?C

ipokineti' septa(

EA ;

Dys&un'tion disto(i' )rade I

susp %AD


12/28

F!"#IN$ DIA$N!SIS

STEMI e9tensive anterior onsetG ? hours #i((ip I


13/28

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


15/28

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.


16/28

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.


18/28

An area o& 'ardia' mus'(e dama)e dueto a'ute o''(usion in a 'oronary artery

that de(ivers +(ood to that area


19/28

"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


20/28

%5INI%A5 7EAT"ES

%hest pain, G


21/28

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


22/28

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!

stemi maisarah

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