Acute Myocardial Infarction

with ST segment Elevation

Presented By :
Nur Mahfuzah Mohamed Fauzi
Supervisor :
dr. Pendrik Tandean,SpPD

PATIENT IDENTITY
Name

: Mr. A
No.MR
: 403962
Age
: 67 years old
Gender
: Male
Date of admittance : 5th october 2009

HISTORY TAKING
Chief complaint: Chest pain
History taking:
Chest pain is felt 5 hours before admitted to the
hospital. Pain felt weighted on his left chest
duration more than 20 minutes, penetrates to the
back of the body and arms. The pain appeared
suddenly after he prayed, pain do not improved
by drugs and rest.
Sweating (+) , Dyspnea (+), cough (-), Nausea (-)
vomiting (-), epigastric pain (-)
Defecation and urination is normal

PAST ILLNESS HISTORY

History of heart disease (+). Patient had been

admitted to Hospital Wahidin 2002 and diagnose

ACS

Family history of heart disease (-)

Diabetes mellitus (-)
Hypertension (-)

RISK FACTOR
Gender

: Male
Age
: 62 years old
Ex-Smoker until 20 years previously. Until then had
smoked 5-10 cigarrettes per day for 30 years
Past history of cardiovascular disease(+)
Hypertension (-)
Alcohol (-)
Diabetes Mellitus (-)

PHYSICAL EXAMINATIONS
General Appearance :

Severe-illness/normal weight/conscious

Vital Sign :
Blood Pressure
: 110/70 mmHg
Pulse
: 72 bpm, regular (right) ;

70bpm regular (left)

Respiratory rate : 22 tpm ; thoracoabdominal
Body temperature : 36,7 C (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 : Ictus Cordis wasnt visible
Palpation : Ictus Cordis wasnt palpable
Percussion : normal heart size
Upper border : left ICS II
Lower border : left ICS V
Right border : right parasternalis line
Left border
: left medioclavicular line
Auscultation : Regular of I/II Heart Sound, no murmur
Abdominal Examination :
Inspection : flat and following breath movement
Palpation
: liver and spleen unpalpable
Percussion : Tympani
Auscultation
: peristaltic sound (+) , normal
Extremities :
Oedema pretibial -/-

LABORATORY FINDINGS
Complete blood count
WBC:10.06 x 103/ul
RBC: 3.96 x106/ul
HGB: 12.0 gr/dl
HCT: 36.3%
PLT: 166 x103/l
Electrolyte
Sodium:136 mmol/l
Potassium : 3.5
Chloride: 102 mmol/l

Blood chemistry
FPG : 126 mg/dl
Ureum : 36 mg/dl
Creatinine : 0.9 mg/dl
SGOT/SGPT: 19 / 25 u/dl
Cholesterol Total : 296 mg/dl
HDL: 42 mg/dl
LDL: 143 mg/dl
Tg: 72 mg/dl
CK: 1260
CK-MB : 144 u/dl

ELECTROCARDIOGRAM (ECG)

aV
R

II

aV
L

III

aVF

ELECTROCARDIOGRAM (ECG)

V1

V4

V2

V5

V3

V6

II

INTERPRETATION
Sinus Rhythm
HR 68 bpm
ST Segment : Elevation at lead II, III and

aVF
Inferior Myocardial Infarction

ECHOCARDIOGRAPHY

ECHOCARDIOGRAPHY

ECHOCARDIOGRAPHY
CONCLUSION :

LV systolic function
Diastolic dysfunction
Coronary Artery Disease
EF + 41%

WORKING DIAGNOSIS
Myocardial infarction with ST

segment elevation (STEMI)

TREATMENT
Total bed rest
Cardiac Diet
O2 2-4 Lpm
IVFD NaCl 0.9% 10 dpm
Fluxum o,6cc/24h/sc
Aspilet 80mg 0-1-0
Clopidogrel 75mg 0-1-0
Farsorbid 5mg 1-1-1
Laxadin syr 0-0-2c
Xanax 0,5mg o-1/2-1

DISCUSSION
Acute Myocardial Infarction

DEFINITION
Myocardial infarction (MI) is the 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.

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

RISK FACTORS
Age > 45 years old
Male gender
Smoking
Hypercholesterolemia and

hypertriglyceridemia,
Diabetes mellitus
Poorly controlled hypertension
Family history
Sedentary lifestyle

CLINICAL FEATURES
Chest pain, >30 minutes
Usually tight, crushing, and band

like
Location in retrosternal
May radiate to left arm, throat,
and jaw
Associated features including
palpitation, sweating,
breathlessness, and nausea.

Diagnose

ns of myocardial ischemia
ECG

Yes

ST segmen elevation ?

Infarction

( Q-wave, non-Q

wave )

No
Lab
Yes

chemical cardiac markers ?

No

Acute Myocardial

NSTEMI
( No ST-Segment
Elevation
Myocardial

Infarction )

Unstable Angina

MANAGEMENT
Bed rest
Diet
Oxygen
Fibrinolytic
Aspirin and/or anti platelet agent
-blocker
Nitrates
Anti Trombolitic
ACE inhibitors

THANK YOU