CASE REPORT CARDIOLOGY

DEPARTMENT

STEMI Extensive Anterior Wall onset 5 hours KILLIP I

Presented by :
Mariana Filda Fadilah L
C11109108
Supervisor :
dr. Magma Purnawan Putra
PRESENTED IN THE CONTEXT OF CLERKSHIP
CARDIOVASCULAR DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY
MAKASSAR
2015

Patient Identity
Name
: Mrs. RA
Age
: 52 years old
Register no.
: 725684
Date of admission :
Sept, 26th
2015

History Taking
Chief complaint : Chest pain
History taking :
It has been felt 4 hours before admitted to the

hospital. Pain felt like press and burn on his left

chest, penetrated to the back body. She told that
she had low back pain 5 days ago.
Fever (-), Epigastric pain (-), Cough (-), vomiting
(+), nausea (+)
Defecation & urination are normal

Past Illness History

History of hypertension (-)

History of Diabetes mellitus (-)
Family history of heart disease (+)

Risk Factor
MODIFIABLE :

Physical Examination
General Appearance : Moderate-

illness/normal BW/conscious

Vital Sign :

Blood Pressure : 120/80 mmHg

Pulse
: 92 bpm, regular
Respiratory rate
: 24 tpm ; thoracoabdominal
Temperature
: 36,7 C (per axilla)

Head Examination :

Eyes : anemia(-), icterus (-), cyanosis (-)

Neck : JVP R+2 cmH20

 Thoracic Examination :

Inspection

: Symmetric left

and right
Palpation
: No mass, no
tenderness
Percussion
: Sonor
Auscultation
: Breath Sound :
vesicular, Rh -/-, Wh -/-

 Cardiac Examination :

Inspection
Palpation

: Ictus Cordis not visible

: Ictus Cordis not

palpable
Percussion : Pecac(+), heart size
increase
Auscultation
: Regular of I/II
Heart Sound, murmur (-)

 Abdominal Examination :

Inspection

: Flat and following

breath movement
Palpation
: No mass, no tenderness,
liver and spleen unpalpable
Percussion
: Tympani
Auscultation : Peristaltic sound (+) ,
normal effect

Extremities :

Edema pretibial -/-, feel warm -/-

Radiology Finding

Conclusion :
Cardiomegal
y with
dilatation
aortae

ECG Interpretation
26th September 2015
Rhythm: Sinus rhythm
P wave : 0,04 s
Heart Rate : 103 bpm, Irreguler
PR interval : 0,12 s
Duration QRS : 0,12 s
Konfiguration
: Q wave V1-V6
Axis : Normoaxis
ST Segment : ST-Elevasi pada Lead V2, V3, V4,
V5, aVL

Conclusion : STEMI Extensive anterior Wall

Laboratory Findings
26 th september 2015
Complete blood count
WBC : 9,6 x 103 /ul
HGB : 13,1 gr/dl
HCT : 38,9 %
PLT : 1322 x 103 /ul
Enzyme
CK : 199 mmol/l
CK-MB
: 21,6 mmol/l
Troponin I : 0,35
mmol/l

Blood chemistry
Ureum : 25 mg/dl
Creatinine : 0,79 mg/dl
SGOT/SGPT : 24/14 u/dl
Chol. Total : 200
mg/dl
HDL : 86 mg/dl
LDL : 113 mg/dl
TG : 71 mg/dl
GDS : 159 mg/dl
Uric acid : 4,2 mg/dl

Echocardiography

Systolic function of LV was decreased, EF

49%
Hypokinetic segmental
Diastolic dysfunction LV grade II

Working Diagnosis
STEMI Extensive Anterior

Wall onset 5 hours KILLIP I

Management
Bed rest
Oxygen 2-4 lpm via nasal canule
IVFD NaCl 0.9% 500 cc/24 hours
Nitrogliserin

Farsorbid 10mg sublingual (if VAS >3)

Antiplatelet
Loading aspilet 160 mg , maintenance 80 mg/24 jam
Loading clopidogrel 300 mg , maintance 75 mg/24 jam
Thrombolitic
Streptase 1.500.000 IU
Heparin bolus 4.000 IU , maintenance 700 iu.jam/via
srynge pump
Antidislipidemia

DISCUSSION

ST ELEVATION MYOCARDIAL
INFARCTION

DEFINITION
Acute

myocardial infarction (AMI) is an

irreversible necrosis of heart muscle due to
prolonged ischemia, which is suddenly
happened.
Imbalance in oxygen supply and demand,
which is most often caused by plaque
rupture with thrombus formation in a
coronary vessel, resulting in an acute
reduction of blood supply to a portion of the
myocardium.

PATHOPHYSIOLOGY
Occurs when coronary blood

flow decreases abruptly after

a thrombotic occlusion of a
coronary artery previously
affected by atherosclerosis.
In

most cases, infarction

occurs
when
an
atherosclerotic
plaque
fissures,
ruptures,
or
ulcerates

PATHOPHYSIOLOGY

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

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

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

RISK FACTORS
Non-Modifiable

Gender and Age

Men, increased risk > age 45

Modifiable
Smoking

Hypertension

Family History

Diabetes Mellitus

CAD diagnosed before age 55 in

Dyslipidemia

Obesity

Lack of physical

Women, increased risk > age 55

father or brother
CAD disease diagnosed before
age 65 in mother or sister

activity

CHANGES IN ECG

DIAGNOSIS

MANAGEMENT

KILLIP CLASSIFICATION
Class

Description

no clinical signs of heart failure

II

rales or crackles in the lungs, an

S3, and elevated jugular venous
pressure

17

III

acute pulmonary edema

30 - 40

IV

cardiogenic shock or
hypotension (systolic BP < 90
mmHg), and evidence of
peripheral vasoconstriction

60 80

Mortality Rate (%)

THANK YOU