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    ST Elevation Myocard Infarction: Rahmatullah Ahmad C111 12301 Supervisor Dr. Pendrik Tandean, SP - PD-KKV, FINASIM

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    Rahmatullah Ahmad
    The document appears to be a case report from a cardiology department describing a 57-year-old male patient admitted with chest pain who was diagnosed with ST elevation myocardial infarction (STEMI). Key details include a history of hypertension, diabetes, and smoking. Examination found elevated cardiac biomarkers and ECG showed ST elevations. The patient received primary percutaneous coronary intervention and medications. The diagnosis was STEMI involving the anterolateral wall within 6 hours of onset.

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    ST Elevation Myocard Infarction: Rahmatullah Ahmad C111 12301 Supervisor Dr. Pendrik Tandean, SP - PD-KKV, FINASIM

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    Rahmatullah Ahmad
    48 views34 pages
    The document appears to be a case report from a cardiology department describing a 57-year-old male patient admitted with chest pain who was diagnosed with ST elevation myocardial infarction (STEMI). Key details include a history of hypertension, diabetes, and smoking. Examination found elevated cardiac biomarkers and ECG showed ST elevations. The patient received primary percutaneous coronary intervention and medications. The diagnosis was STEMI involving the anterolateral wall within 6 hours of onset.

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    The document appears to be a case report from a cardiology department describing a 57-year-old male patient admitted with chest pain who was diagnosed with ST elevation myocardial infarction (STEMI). Key details include a history of hypertension, diabetes, and smoking. Examination found elevated cardiac biomarkers and ECG showed ST elevations. The patient received primary percutaneous coronary intervention and medications. The diagnosis was STEMI involving the anterolateral wall within 6 hours of onset.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    48 views34 pages

    ST Elevation Myocard Infarction: Rahmatullah Ahmad C111 12301 Supervisor Dr. Pendrik Tandean, SP - PD-KKV, FINASIM

    Uploaded by

    Rahmatullah Ahmad
    The document appears to be a case report from a cardiology department describing a 57-year-old male patient admitted with chest pain who was diagnosed with ST elevation myocardial infarction (STEMI). Key details include a history of hypertension, diabetes, and smoking. Examination found elevated cardiac biomarkers and ECG showed ST elevations. The patient received primary percutaneous coronary intervention and medications. The diagnosis was STEMI involving the anterolateral wall within 6 hours of onset.

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    Cardiology and Vascular Medicine Department

    Medical Faculty
    Hasanuddin University

    CASE REPORT
    July 2016

    ST ELEVATION MYOCARD INFARCTION


    Rahmatullah Ahmad
    C111 12301
    Supervisor
    dr. Pendrik Tandean, Sp.PD-KKV, FINASIM
    DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK
    PADA BAGIAN KARDIOLOGI DAN KEDOKTERAN VASKULER
    FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN
    MAKASSAR
    2016

    PATIENT IDENTITY
    NAME

    : MR. AH

    AGE

    : 57 YEARS OLD

    MR

    : 530703

    DAY OF ADMISSION

    : JULY 21TH, 2016

    HISTORY TAKING
    Main Complain : Chest Pain
    Present History:
    Chest pain suffered since 4 hours before admitted to Hospital.
    Suddenly while wake up in the morning. The pain is described like
    through to the back, on the left side of the chest, with cold
    sweating, and radiating to the left arm and neck. The chest pain felt
    more than 30 minutes duration. There is dispnea on effort. There is
    nausea and heartburn. There is no fever, cough and vomitting.
    Micturition and defecation are normal.

    HISTORY TAKING
    There is no history of chest pain before
    There is history of hypertension, and take irregular medicine
    There is history of diabetes mellitus, and take irregular
    medicine
    There is family history of heart disease (his father)
    There is history of alcohol consuming
    There is history of smoking since 7 years old, 2 pack a day and
    stop 10 years ago

    RISK FACTORS
    Non modified risk factors :
    Age 57 years old
    Gender : male
    Genetics
    Modified risk factors :
    Smoking
    Hypertension
    Diabetes mellitus
    Alcohol

    PHYSICAL EXAMINATION
    General status:
    Moderatly ill / Obesity I / Composmentis
    Vital sign:
    Blood Pressure
    : 120/80 mmHg
    Pulse
    : 110 beats/minute, reguler
    Respiratory Rate
    : 26 times/minute
    Temperature : 36.8 degree celcius

    PHYSICAL EXAMINATION
    Head examination

    Thorax examination

    Eyes: anemic -/-, icterus -/ Lips : cyanosis (-)


    Neck
    : lymphadenopathy
    JVP r +2 cmH2O (30)

    Insp. : Symmetrical r=l,


    normochest
    Palp. : Respiratory movement r=l
    (-),
    Perc.
    : Sonor
    Ausc.: Vesicular
    Ronchi +/+, basal
    wheezing -/-

    PHYSICAL EXAMINATION
    CARDIAC EXAMINATION
    INSP.
    : ICTUS CORDIS WASNT VISIBLE
    PALP.
    : ICTUS CORDIS WASNT PALPABLE
    PERC. :
    UPPER BORDER 2ND ICS SINISTRA
    RIGHT BORDER 4TH ICS LINEA PARASTERNALIS
    DEXTRA
    LEFT BORDER 5TH ICS LINEA AXILLARIS ANTERIOR
    SINISTRA
    AUSC. : I/II HEART SOUND CLEAR AND REGULAR,
    MURMUR (-)

    PHYSICAL EXAMINATION
    Abdominal examination
    Inspection
    Auscuscultation
    Palpation
    not palpable
    Percusion

    : Flat and following breath movement


    : Peristaltic sound (+), normal
    : Tenderness (-), Liver and spleen was
    : Tympany, shifting dullness (-)

    Extremities
    Edema: Pretibial -/-, Dorsum pedis -/-

    ELECTROCARDIOGRAPHY

    Electrocardiography
    Rhythm
    : Sinus
    tachycardi
    Heart rate : 125 bpm
    Axis
    : Normoaxis 75
    P Wave : Normal
    PR interval: 0,16 s
    Duration QRS: 0,04 s;
    configuration: Low voltage
    ST-segment: ST elevation in
    lead V3-V6
    T Wave : T inverted in Lead
    I, aVL.

    Conclusion : Sinus tachycardi, HR 125 bpm, normoaxis, myocard


    infarc anterolateral wall.

    LABORATORY EXAMINATION
    TEST

    RESULT

    NORMAL VALUES

    WBC

    14.7 x 103 /mm3

    4,0 10,0 x 103 /mm3

    RBC

    5.57 x 106 /mm3

    4,0 6,0 x 103 /mm3

    Hb
    HCT

    17.1 gr/dl
    42 %

    12,0 16,0 gr/dl


    37,0 47,0%

    PLT

    192 x 103 /mm3

    150 400 x 103 /mm3

    Ureum
    Creatinin
    Random Blood
    Glucose

    24 mg/dl
    0.95 mg/dl

    10 - 50 mg/dl
    M(<1,3); F(<1,1) mg/dl

    342 mg/dl

    140 mg/dl

    LABORATORY EXAMINATION
    CK
    CK-MB
    Troponin I
    SGOT
    SGPT

    899 U/l
    55.4 U/l
    7.44 ng/ml
    94 mg/dl
    37 mg/dl

    Uric Acid

    6.0 mg/dl

    Natrium
    Kalium
    Clorida
    Total
    Cholesterol

    135 mmol/l
    4.2 mmol/l
    100 mmol/l

    M(<190); F(<167) U/l


    < 25 U/l
    <0,01 ng/ml
    < 38 U/l
    < 41 U/l
    M(3,4-7,0); F(2,4-5,7)
    mg/dl
    135 145 mmol/l
    3,5 5,1 mmol/l
    97 111 mmol/l

    171 mg/dl

    200 mg/dl

    HDL

    45

    M(>55); F(>65) mg/dl

    LDL
    Trigliserida

    115
    82

    <130 mg/dl
    200 mg/dl

    RADIOLOGY FINDING
    CHEST X-RAY (22-072016)
    Cardiomegaly (CTI 0,66)
    with lung udema

    DIAGNOSIS

    ST Elevation Myocardial Infarction


    (STEMI) Anterolateral wall onset < 6
    hours, KILLIP II.
    Congestive Heart Failure
    Diabetes Mellitus Type II

    PLANNING

    Bed rest
    Anti Angina:
    Oksigen 4 LPM via nasal canule
    - Farsorbid 10 mf/8 hours/oral
    IVFD NaCl 0,9 % 500 cc/24 jam
    Anti Coagulant:
    Primary Percutaneous Coronary Intervension
    - Fondaparinux (arixtra) 3,5
    Anti Platelet Aggregation:
    mg/
    - Aspirin (loading dose 160 mg)
    24 hours/SC
    maintenance 1x80 mg
    Atorvastatin 40 mg/24 hours/oral
    - Clopidogrel (loading 300 mg)
    Ramipril 2,5mg/24 hours/oral
    maintenance 1x75 mg
    Alprazolam 0,5mg/24 hours/oral
    (night)
    Laxadyn syr 15cc/24 hours/oral
    Novorapid 8-8-8 IU / sc
    Levemir 0-0-10 IU / sc

    ACUTE MYOCARD INFARTION

    DEFINITION

    RISK FACTORS
    o
    o
    o
    o
    o
    o
    o

    Modifiable
    Smoking
    Hypertension
    Obesity
    Diabetes Mellitus
    Dyslipidemia
    Low HDL < 40
    Elevated LDL / TG

    Non Modifiable
    o Gender and age:
    - male after age 45 y.o
    - female after age 55 y.o
    o Family History in first
    degree
    relative > 55 y.o for
    male/ 65 y.o for female

    PATHOPHYSIOLO
    GY

    American Heart Association: http://watchlearnlive.heart.org

    American Heart Association: http://watchlearnlive.heart.org

    American Heart Association: http://watchlearnlive.heart.org

    American Heart Association: http://watchlearnlive.heart.org

    ELECTROCARDIOGRAPHY

    BIOMARKERS
    Biochemical marker for
    detection of myocardial necrosis
    First rise
    after
    AMI

    Peak
    after
    AMI

    Return
    to
    normal

    CK-MB

    4h

    24 h

    72 h

    Myoglobi
    n

    2h

    6-8 h

    24 h

    Troponin
    T

    4h

    24 - 48
    h

    5 21
    d

    Troponin
    I

    3-4 h

    24 36
    h

    5 14
    d

    PRINCIPLE OF
    TREATMENT

    MANAGEMENT

    Oxford Handbook of Clinical Medicine 6th Edition

    COMPLICATION

    Oxford Handbook of Clinical Medicine 6th Edition

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