STEMI
STEMI
STEMI
Name : Ms. S
Age : 75 years old
Occupation : Farmer
Address : Moncongloe lappara, Maros
MR : 727033
Date of Admission : January 13th 2016
HISTORY TAKING
Past history:
history of chest pain on and off
History of hypertention since 1 year ago
History of heart disease is none
History of Diabetes Mellitus is none
HISTORY TAKING
Abdomen :
Inspection : flat, follows breath movement
Auscultation : peristaltic (+), normal
Palpation : liver and spleen not palpable
Percussion : tympani
Extremities :
Edema (-)
ELECTROCARDIOGRAPHY
Sinus tachycardia
HR : 107bpm
Regularity: regular
Axis : normoaxis
PR interval : 0.20 s
QRS rate : 0.08 s
QRS complex : S V1+ R
V5/V6> 35mm
ST segmen :
ST segmen elevation on
lead V1-V3
ST depresion on Lead I,
aVL, V5, V6
Conclusion :
Sinus tachycardia, HR :
107bpm, anteroseptal
walls myocardial
infarction,
lateral wall ischemic.
LABORATORY RESULTS
TEST RESULT NORMAL TEST RESULT NORMAL
VALUE VALUE
WBC 17.700 x 103/uL 4.0 10.0 x 103 Tot.Choles 238mg/dl 200
HDL 51 mg/dl >59
RBC 4.6 4.0 6.0 x 106 LDL 171 mg/dl 130
HGB 12.1 12 16 Trigliserida 134 mg/dl 200
HCT 39 37 48 Ureum 40 10-50
PLT 279x 103/uL 150 400 x 103 Kreatinin 0.96 0,5-1,2
Troponin I 1.61 <0,01
PT 12.3 10 - 14
CK 154,00 <190
APTT 22.7 22,0 - 30,0
CKMB 19.5 <25
INR 1.18
Natrium 148 136 - 145
GDS 363mg/dl 140
Kalium 3,1 3,5 - 5,1
GD2PP - <200
Klorida 113 97 - 111
SGOT 28 u/L <38
Asam Urat - 3,4-7,0
SGPT 26 u/L <41
CHEST X-RAY
Result :
Cardiomegaly with
signs of pulmonary
edema
Dilatatatio elongation
et atherosclerosis
aortae
DIAGNOSIS
Diagnostic
ECG changes
Non-
Modifiable
Modifiable
Smoking
Gender & Age
Hypertension Men > 45 years old
Diabetes mellitus Women > 55 years old
Hypercholesterolemia
Family history
Obesity Heart disease in biological
brother or father > 55 years
Psychosocial stress old
Heart disease in biological
Lack of physical activity sister or mother > 65 years old
CARDIAC BIOMARKERS
GOAL OF TREATMENT
Hemodynamic
Relieve pain
stabilization
Clopidogrel 300-600mg loading dose and 75mg daily continued for at least 14 days and up to 12 months.
Nitroglycerin :
0.4 mg SL tablets every 3-5 min up to 3 times; if effect is not sustained, can continue with an IV drip of 50mg in 250mL Dextrose
5%.
Morphine 2-5mg iv (can be administered again in 5-30 minutes later)
Fibrinolytic therapy:
Streptokinase 1.5million units iv
Actilyse 0.75mg/kg weight body
Anticoagulation therapy:
Low Molecular Weight Heparins (Fluxum) 0.4cc/sc for up to 8 days post-MI.
Unfractionated heparin
Anti Hypertension Drugs
Lipid Lowering Agents
Complication
THANK YOU