You are on page 1of 26

dr.

Beny Hartono, SpJP, FIHA

Assessing Chest pain


Character Time of onset, duration, frequency Changes in tempo Exacerbating and alleviating factors Pain during situation associated with increased myocardial O2 demand ( e.g. exertion, stress )

SINDROM KORONER AKUT Merujuk pd sekumpulan keluhan dan tanda klinis yang sesuai dengan iskemia miokard akut Mencakup Infark miokard akut ( dgn elevasi /depresi segmen ST , gelombang-Q dan non gel Q) dan angina tidak stabil ( UAP)

Sindrom Koroner Akut


Tanpa elevasi ST NSTEMI Elevasi ST

Angina Tdk Stabil

Infark Miokard Akut NQMI Qw MI


Kursus SKA k

Immediate Assessment in ED
Vital signs, including blood pressure Oxygen saturation IV access 12-leads ECG Brief, targeted history and physical exam (to identify reperfusion candidates) Fibrinolytic check list; check contraindications Obtain initial cardiac markers Portable Chest X-ray < 30 min. Assess for the following : -Heart rate > 100 bpm and SBP < 100 mmHg -Pulmonary edema/rales or -Signs of shock any of these conditions is present, consider triage to a facility capable of cardiac catheterization and revascularization

If

Early Repolarisation !!!

LOKASI ISKEMIA BERDASARKAN PERUBAHAN DI SANDAPAN EKG


SANDAPAN
II

LOKASI ISKEMIA / INFARK Inferior Anteroseptal Anterior Anterior ekstensif Lateral Apikal Posterior Ventrikel kanan

,III, aVF V1,V2,V3 V1-V4 V1- V6 I,aVL ,V5,V6 I, V6 V7-V9 V4R

Emergency Department (1)


AMI Protocol -ECG screening within 10 minutes -Door-to-drug time < 30 minutes -Door-to-balloon time inflation < 90 minutes
For all patients with ischemic-type chest pain, provide supplementary oxygen, IV access, and continuous ECG monitoring

Emergency Department (2)


Reperfusion therapy for ST-segment elevation MI (STEMI) - Rule out contraindications and assess riskbenefit ratio. -Consider PCI if ineligible for fibrinolytics -angiography for cardiogenic shock (angioplasty or CABG if indicated)
Prompt aspirin (160-325 mg) for all patients with AMI who are reperfusion candidates.

Emergency Department (3)


Beta-blockers for all patients without contraindications.
IV nitroglycerin for initial 24-48 hrs in patients with AMI and CHF, large anterior infarction, persistent ischemia, or hypertension.

Fibrinolytics
Absolute Contraindications :
-Any prior intracranial hemorrhage (ICH) -Known structural cerebral vascular lesion (eg. AVM) -Known malignant intracranial neoplasma -Ischemic stroke within 3 month EXCEPT acute ischemic stroke within 3 hrs -Suspected aortic dissection -Active bleeding or bleeding diasthesis -Significant closed head trauma or facial trauma within 3 months

Fibrinolytic
Relative Contraindications :
- Check your handbook !!!

Summary : Guideline 2010

Thank you

You might also like