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    Astrinita Lestari Suyata c11108174 STEMI

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    jefrizalzain
    This case report summarizes the medical history and hospital admission of a 65-year-old male patient presenting with chest pain. The patient has a history of hypertension, diabetes, and previous strokes. Upon examination and testing, he was found to have signs and symptoms consistent with an ST-elevation myocardial infarction of the anterior wall occurring over the past 9 hours. Initial management included oxygen, medications to relieve symptoms and prevent complications, and further cardiac testing. The report discusses acute coronary syndrome, risk factors, diagnostic criteria, biomarkers, treatment approaches, and prognosis based on Killip classification and TIMI score.

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    Astrinita Lestari Suyata c11108174 STEMI

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    jefrizalzain
    184 views30 pages
    This case report summarizes the medical history and hospital admission of a 65-year-old male patient presenting with chest pain. The patient has a history of hypertension, diabetes, and previous strokes. Upon examination and testing, he was found to have signs and symptoms consistent with an ST-elevation myocardial infarction of the anterior wall occurring over the past 9 hours. Initial management included oxygen, medications to relieve symptoms and prevent complications, and further cardiac testing. The report discusses acute coronary syndrome, risk factors, diagnostic criteria, biomarkers, treatment approaches, and prognosis based on Killip classification and TIMI score.

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    This case report summarizes the medical history and hospital admission of a 65-year-old male patient presenting with chest pain. The patient has a history of hypertension, diabetes, and previous strokes. Upon examination and testing, he was found to have signs and symptoms consistent with an ST-elevation myocardial infarction of the anterior wall occurring over the past 9 hours. Initial management included oxygen, medications to relieve symptoms and prevent complications, and further cardiac testing. The report discusses acute coronary syndrome, risk factors, diagnostic criteria, biomarkers, treatment approaches, and prognosis based on Killip classification and TIMI score.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    184 views30 pages

    Astrinita Lestari Suyata c11108174 STEMI

    Uploaded by

    jefrizalzain
    This case report summarizes the medical history and hospital admission of a 65-year-old male patient presenting with chest pain. The patient has a history of hypertension, diabetes, and previous strokes. Upon examination and testing, he was found to have signs and symptoms consistent with an ST-elevation myocardial infarction of the anterior wall occurring over the past 9 hours. Initial management included oxygen, medications to relieve symptoms and prevent complications, and further cardiac testing. The report discusses acute coronary syndrome, risk factors, diagnostic criteria, biomarkers, treatment approaches, and prognosis based on Killip classification and TIMI score.

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    Case Report

    BY : Astinita Lestari Suyata ( C 111 08 174) SUPERVISOR : Dr. Idar Mappangara, SpPD, SpJP, FIHA

    Medical Faculty of Hasanuddin University, Makassar 2013

    Patient Identity
    MR number Name Age Date administered : : : : 151821 Mr.SU 65 years old May 4th 2013

    History Taking
    Chief complaint: Chest pain It was felt since 9 hours before admitted to hospital. It was felt at the middle of chest, like pressed by a heavy things and radiated to his neck and left arm. It occured suddenly with duration more than 20 minutes, didnt trigerred by activity and didnt relieved by rest.

    Shortness of breath (+), since 1 months ago, he can sleep with 12 pillow. DOE (+) , PND (-), Orthopnea (-)
    Cough (-) Epigastric pain (+), Nausea (+), vomit (-), sweating (+) Defecation: normal Micturition: normal

    Past Medical History


    History of hypertension (+) since long time ago and took medicine regularly History of diabetes mellitus (+) since 10 years ago took medicine regularly History of dyslipidemia (-) History of smoking (-) History of hospitalization with stroke in 2000, 2006, and 2011 History of chest pain before (-) Family history (-)

    Risk Factor
    Modifiable : - Hypertension - Diabetes mellitus Non - Modifiable : - Gender (male) - Age : 65 years old - Stroke

    Physical Examination
    General status
    Moderate illness/well nourished/conscious

    Vital sign
    BP : HR : RR : T : 130/90 mmHg 80 x/min 28x/min 36.70 C

    Physical Examination
    Regional status
    Head Examination
    - Eyes - Lip - Neck : Anemis -/-, icterus -/: Cyanosis (-) : JVP R +3 cmH2O

    Chest Examination
    - Inspection - Palpation - Percussion - Auscultation : Symmetric right = left, normochest : No mass, no tenderness : Sonor, lung-liver border in ICS VI right anterior : Breath sound : Bronchovesicular Additional sound : Ronchi +/+ basal, wheezing -/-

    Cardiac Examination
    - Inspection : Ictus cordis invisible - Palpation : Ictus cordis impalpable - Percussion : Right heart border in right parasternal line, left heart border midclavicle line ICS V - Auscultation : Regular of I/II heart sound, no murmur

    Abdominal
    - Inspection - Auscultation - Palpation - Percussion : flat, following breath movement : Peristaltic sound (+), normal : No mass, no tenderness, liver and spleen unpalpable : tymphani, ascites (-)

    Extremities
    - Oedema pretibial -/- Oedema dorsum pedis -/-

    Electrocardiography (ECG)

    Interpretation:
    Rhythm : Sinus rhytm HR/QRS rate: 83 x/min Axis : Normal P wave: 0.08 sec PR interval: 0.2 sec QRS Complex: 0.16 sec ST segmen: ST elevasi V1-V4 T wave : T inverted pada lead II, III, AVF

    Laboratory Findings
    RESULT WBC RBC 8.440 [10^3/uL] 4.05 [10^6/uL] NORMAL 4.0-10.0 4.00-5.00

    HGB
    HCT

    12.9 [g/dL]
    37.8[%]

    12.0-16.0
    37.0-48.0

    PLT
    CK CK-MB TROPONIN-T CHOL TOT

    271[10^3/uL]
    760 [U/L] 52 [U/L] 0.27 288

    150-400
    L(<190), P(<167) <25 negative 150-200

    RESULT LABORATORY FINDINGS

    NORMAL

    GDS
    HbA1C UREUM CREATININE SGOT SGPT NATRIUM KALIUM

    269
    5.9 45 1.4 47 32 143 3.8

    140
    4-6 10-50 L(<1.3), P(<1,1) <38 <41 136-145 3.5-5.1

    CHLORIDE

    1109

    97-111

    Thorax Photo
    Interpretation: In Normal Limit

    Echocardiography

    Echocardiography
    Interpretation Sistolic and diastolic LV disfunction, EF 38% LVH (+) Anterior, apical, apico septal, and mid septal hipokinetic EV function good (TAPSE 1,9) MR Mild-Mud

    Working Diagnosis
    STEMI Anterior Wall Onset 9 Hrs KILLIP II Hypertention Gr I DM type II

    Initial Management
    Bed rest Cardiac Diet O2 3-4 ltr/min

    IVFD NaCl 0,9 % 10 drips/min


    Isosorbid dinitrat : Cedocard 2mg/amp/jam Simvastatin 20 mg 0 0 1 Anti platelet aggregation : - Aspirin : Aspilet 80 mg loading dose 2 tab 80 mg 0 1 0 - Clopidogrel: Plavix 75 mg loading dose 4 tab 75 mg 1 0 0 Anticoagulant : Arixtra 2,5 mg/24 h/ SC ARB : Valsartan 80 mg 0-0-1 Anti anxietas : Alprazolam 0,5 mg 0 - 0 - 1 Stool softener : Laxadyn syrup 0 - 0 - 2C Novorapid 6-6-6 Lantus 0-0-12

    DISCUSSION :

    Acute Coronary Syndrome


    (ST-Elevation Myocard Infarction)

    Myocardial ischemia is caused by imbalance between myocardial oxygen supply and myocardial oxygen consumption.
    Myocardial infarction (MI) is the rapid development of myocardial necrosis.

    EUROPEAN HEART JOURNAL. GUIDELINES ON THE MANAGEMENT OF STABLE A NGINA PECTORIS

    Regions of the Myocardium


    Lateral I, AVL,V5-V6

    Inferior II, III, aVF

    Anterior / Septal V1-V4

    EUROPEAN HEART JOURNAL. GUIDELINES ON THE MANAGEMENT OF STABLE A NGINA PECTORIS

    Diagnosis

    WHO Diagnostic Criteria


    Clinical history of ischaemic type chest pain lasting >20 minutes Changes in serial ECG tracings Rise and fall of serum cardiac biomarkers such as creatinine kinase-MB fraction and troponin

    HTTP://EN.W IKIPEDIA.ORG/WIKI/MYOCARDIAL_INFARCTION

    CARDIAC BIOMAKERS

    RISK FACTORS FOR ATHEROTHROMBOSIS


    Hypercoagulable states
    Homocysteinemia Diabetes Obesity Genetics Life-style (e.g, smoking, diet, lack of exercise)
    Hyperlipidemia

    Hypertension Gender Infection? Age

    Atherotrombotic Manifestations (MI, Ischemic stroke, Vascular death)


    American Heart Association, Heart and Stroke facts: 1997 Statistical supplement; Wolf Stroke 1990;21 (SUPPL 2):II-4II-6;Laurila et al. arterioscle TrombVasc bio 1997;17:2910-2913;Grau et al. Stroke 1997;26;1724-1729; Graham et al JAMA 1997;277: 1775-1781;Brigden Postgrad Med;101(5);249262

    Treatment
    Relieve pain

    Hemodinamic stabilitation
    Miokardial reperfusion

    Prevent the complication

    KABO P. BAGAIMANA MENGGUNAKAN OBAT-OBAT KARDIOVASKULAR SECARA RASIONAL. 2010

    Treatment
    Oxygen

    Surgical revascularization
    PTCA (percutaneous transluminal coronary angioplasty)

    Nitrate
    Anti platelet agent Anti koagulan

    Morphine / pethidine
    Trombolitic -blocker

    CABG (coronary artery bypass grafting )

    ACE inhibitors
    Lipid lowering agent
    KABO P. BAGAIMANA MENGGUNAKAN OBAT-OBAT KARDIOVASKULAR SECARA RASIONAL. 2010

    Prognosis
    KILLIP CLASSIFICATION
    Class Description no clinical signs of heart failure I rales or crackles in the lungs, an S3, II and elevated jugular venous pressure acute pulmonary edema III cardiogenic shock or hypotension IV (systolic BP < 90 mmHg), and evidence of peripheral vasoconstriction Mortality Rate (%) 6 17 30 - 40 60 80

    HTTP://EN.W IKIPEDIA.ORG/WIKI/KILLIP_CLASS

    TIMI score for UAP and NSTEMI


    1. Age > 65 years 2. More than 3 risk factors - hypertension, diabetes mellitus, smoking, family history, dyslipidaemia

    3. Prior coronary angiogram showing > 50% stenosis


    4. Aspirin use in the past 7 days 5. At least 2 episodes of rest pain in the past 24 hours 6. ST deviation on admission > 1 mm 7. Elevated cardiac markers - CK, CKMB, Troponin T Low 0-2 : < 8.3% risk of adverse cardiac event Intermediate 3-4 : < 19.9 % risk of adverse cardiac event High 5-7 : up to 41% risk of adverse cardiac event
    HTTP://DOKNOTES.WIKIDOT.COM/TIMI-SCORE-FOR-UNSTABLE-ANGINA-AND-NSTEMI

    Thank You

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