stemi inferior banis

7/28/2019 Stemi Inferior Banis

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PRESENTED BY :

IIN BANISWIRA C11108193

BAGIAN ILMU ANESTESI PERAWATAN INTENSIF DAN MANAJEMEN NYERI

Supervisor :

dr. Khalid Saleh, Sp. PD,KKV,FINASIM


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MR number : 579492

Name : Mr. J

Age : 58 years old

Date administered : November 20th 2012


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Chief complaint: Chest pain

The pain was felt a day ago after coming from the garden, before admitted

to the hospital. The pain felt pressed by heavy things, radiated to left arm,

but no penetrated to the back body. The pain was felt for more than 30

minutes and didnt relieved by rest. During the attack, patient feel

sweating, nausea, vomit (-), palpitations (-), shortness of breath (-).

Cough (-), history of cough(-)

Dizziness (-), Headache (-) , Fever (-)

PND (-), DOE (-)

Defecation and urination : normal


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History of heart disease ( - )

History of hypertension is (-) History of diabetes melitus (-)

History of dyslipidemia is unknown

History of smoking (+) +25years


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General status

Moderate illness/well nourished/conscious

Vital sign BP : 100/70 mmHg

HR : 60 x/min

RR : 24 x/min

T : 36.50 C

Head : Anemia (-) , Icterus ()

Neck : JVP R-2cm H20


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Lung : Vesicular, Rhonchi -/- , Wheezing -/-

Cor : I : Ictus cordis not visible

P : Ictus cordis not palpable

P : Dull, normal heart size

-Upper border : left 2nd ICS -Right border : right parasternalis line

-Left border : left medioclavicular line

A : Heart Sound I/II pure regular, murmur(-)

Abdomen :

Inspection : flat and following breath movement Auscultation : peristaltic sound (+) , normal

Palpation : liver and spleen unpalpable

Percussion : tympani, ascites (-) Extremities : Edema -/-


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Right ECG


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Posterior ECG


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Rhythm : Sinus rhythm

P wave : 0,08 s Heart Rate : 50 x/min, reguler

PR interval : 0,24 s

Duration QRS : 0,12 s

Axis : +10

ST Segment : ST elevation II,III, AvF


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Conclusion:

Cardiomegaly with dilatatio,elongatio et atherosclerosis aorta


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Date of lab test Types of test Result

November 20th 2012 WBC: 13,78 x103 mm3 (4,0 10,0 x

103)

PLT: 182 x103 mm3 ( 150 400 x 103)

RBC: 4,72 x106 mm3 ( 4,0 6,0 x 106)

HGB: 14,0 gr/dl ( 12 16 )

HCT: 39,8% ( 37

48 )

Blood chemistry Ureum : 26 mg/dl ( 10 50 )

Creatinin : 0,9 mg/dl ( < 1,3 )

SGOT : 158 /l ( < 38 )SGPT : 39 /l ( < 41 )

Chol Total: 189 mg/dl ( 200 )

Chol HDL: 35 mg/dl ( > 55 )

Chol LDL: 116 mg/dl ( < 130 )

Triglyceride: 221 mg/dl ( 200 )GDS 131 mg/gl (140)

Cardiac enzymes CK : 2643 ( < 190 )

CKMB : 250 u/l (


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Inferior STEMI onset >12 hours, Killip I


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Yowler, C.J. Burn Injuries (Critical Care in Severe Burn Injury). In : Smith, C.E. Trauma Anesthesia. Cambridge : Cambridge University Press.2008. : 1

O2 2-4 lpm ( via nasal canule )

IVFD NaCl 0,9% 20 dpm

Aspilet 80mg 0-1-0 Plavix 75mg 0-1-0

Simvastatin 20 mg 0-0-1

Lovenox 0,6 cc/12 h/ SC

Fasorbid 5 mg/SL

Alprazolam 0,5 0-0-1

Laxadyn syr 0-0-2 C


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ST ELEVATION MYOCARDIAL

INFRACTION


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Myocardial infarction (MI) rapid development of myocardial

necrosis caused by a critical imbalance between the oxygen supply

and demand of the myocardium.

This usually results from plaque rupture

with thrombus formation in a coronary

vessels, resulting in an acute reduction

of blood supply to a portion of the

myocardium.


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Occurs when coronary blood flow decreasesabruptly after a thrombotic occlusion of acoronary artery previously affected byatherosclerosis.

In most cases, infarctionoccurs when anatherosclerotic plaquefissures, ruptures, orulcerates.


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ACS describe a group of conditions resulting from acute myocardial

ischemia (insufficient blood flow to heart muscle) ranging from

unstable angina to myocardial infarction.


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Non- Modifiable Modifiable

Gender and Age

Men, increased risk after age 45

Women, increased risk after age 55

Family History

Heart disease diagnosed before age

55 in father or brother

Heart disease diagnosed before age

65 in mother or sister

Smoking

Hypertension

Diabetes Mellitus

Dyslipidemia

Obesity

Lack of physical activity


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1. Clinical history of ischaemic type chest painlasting >20 minutes

2. Changes in serial ECG tracings3. Rise and fall of serum cardiac biomarkers

such as creatinine kinase-MB fraction andtroponin


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1. Chest pain, >30 minutes2. Usually tight, crushing, and band like3. Location in retrosternal

4. May radiate to left arm, throat, and jaw5. Associated features including palpitation,

sweating, breathlessness, and nausea.


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ST segment elevation

over area of damage

ST depression inleads opposite

infarction

Pathological Q waves

Reduced R waves Inverted T waves


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No

Yes

YesNo

Acute Myocardial Infarction(STEMI)

NSTEMI( Non ST-Elevation

Myocardial Infarction )

Unstable

Angina

Signs of myocardialischemia

Biochemical cardiac markers ?

ECG

Lab

ST segmen elevation ?


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Fixing the chest pain and fearness

o Bed resto Dieto O2 2-4 lpmo Nitrat sublingual/oral/IV

o Antiplatelet : aspirin and clopidogrelo Morfin/petidine

o Diazepam 2-5mg/8 hour Stabilizing the hemodynamic ( blood pressure and pheripheral pulse control)

o -blocker

o Calcium chanel blocker (CCB)

o ACE-Inhibitor Reperfusion of the myocard

o Thrombolitik


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Congestive heart failure

Myocardial rupture

Arrhythmia

Cardiogenic shock

Pericarditis


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Class Description Mortality Rate (%)

I No clinical signs of heartfailure

6

II Rales or crackles in thelungs, an S3, and elevatedjugular venous pressure

17

III Acute pulmonary edema 30 - 40

IV Cardiogenic shock orhypotension (systolic BP< 90 mmHg), andevidence of peripheralvasoconstriction

60 80

KILLIP CLASSIFICATION


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Thank you for

your attention

stemi inferior banis

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