Professional Documents
Culture Documents
Serangan Jantung
Proses adaptasi terhadap perubahan
yang sangat cepat
Kompensasi
Dekompensasi
Saiful
Patient
Anwar
Hospital
General
Practitioner
role
Self
PHC
Medication
Aterosklerosis SKA
Atherogenesis
Progression of Plaque toward rupture
Progression of Plaque toward rupture
Plaque Rupture
Platelet aggregation in ruptured plaque
Lipid core
Adventitia
Weissberg, 1999
Thrombus formation
Thrombus forms and
extends into the lumen
Thrombus
Lipid core
Adventitia
Weissberg, 1999
Plaque Rupture Toward Occlusion
Spektrum SKA
Unstable Angina Pectoris :
(EKG normal, Trop T/I (-))
Acute Non ST-Elevation Myocardial Infarction
(NSTEMI) :
(EKG normal/ST depresi/T inversi dan Trop
T/I (+))
Acute ST-Elevation Myocardial Infarction
(STEMI) :
EKG ST elevasi dan Trop T/I(+)
Bagaimana Diagnosa SKA ?
Membedakan Nyeri dada: SKA?
Ischemic
Stenosis Aorta
Regurgitasi Aorta
Hypertrophic Cardiomyopathy
Angina pada Hypertensi
Hipertensi pulmonal berat
Non Ischemic
Diseksi Aorta
Pericarditis
Mitral valve prolaps
Gastro intestinal
Esophageal spasm/reflux/rupture
Peptic Ulcer
Neuromusculoskeletal
Costochondritis
Herpes zoster
Chest wall pain dan tenderness etc
11th ed Hurst’s the heart 2005
DD chest pain
Pulmonary
Pulmonary emboli
Pneumothorax
Penumonia with pleural involvement
Pleurisy
Psychogenic
Axiety/depression/cardiac psychosis etc
Sadar-Koma
TD: Hypertensi-Normal-Hypoptensi
HR: Regular-irregular/ Bradycardia-Tachycardia
pulseless
RR: Tachypnea-apnea
Cor: Regular-iregular, murmur, gallop
Pulmo: Normal-Rales- wheezing
Ext: dingin/hangat, edema+/-, etc.
EKG
3rd degree
Ventricular Tachycardia (VT)
Ventricular Tachycardia (V T)
Coarse
Fine
Peningkatan Enzym jantung
Troponin T/Troponin I
CKMB
Chest x-ray
CTR 62%
Aorta elongation
Po normal
Cardiac Waist (+)
Apex lat downward
Congestion (+)
Non Invasif
Invasif
Universal Definition of Myocardial Infarction
O2
Bed rest
Pain killer
Nitrate and anti-ischemia
Antiplatelet : Aspirin, Clopidogrel
Heparin
HTN
Hyperglicemia
Treat the complication etc
Terapi STEMI
O2
Bed rest
Pain killer
Nitrate and anti-ischemia
Antiplatelet : Aspirin, Clopidogrel
Fibrinolytic time to neddle : 30 m/PCI
HTN
Hyperglicemia
Treat the complication etc
Fibrinolitik
Manfaat bila onset < 12 jam, optimal bila onset <
3 jam
Bila dikirim ke RS dengan PCI > 90 menit,
fibrinolitik
Konsep baru : Fibrinolitik di Ambulan menuju RS
Perhatikan kontraindikasi fibrinolitik
Awasi ketat komplikasi fibrinolitik seperti
perdarahan, stroke, syok dll
Perhatikan tanda tanda keberhasilan: nyeri
hilang, ST elevasi turun >50%, Junctional
VES(+), bila gagal rescue PCI
Kontra Indikasi Absolut
1. Time to balloon : 90 m
2. Yang dibuka hanya Culprit lesion (pembuluh
darah tersumbat yang menyebabkan IMA kali ini)
saja
3. Aliran darah yang diintervensi kembali lancar
Primary PCI Case
A 53 yo man reffered from a private
hospital for primary PCI
A typical chest after exercise 2 hr prior to
admission
ECG send by fax
PCI appointment via phone
Patient directly transfer red to cath lab
Komplikasi MI
Mechanical
Electrical
Ischemia
Embolic
Inflammation
Komplikasi Mekanik
Major Minor
Acute pulmonary edema Night cough
PND or orthopnea Tachycardia >120
Crackles Pleural effusion
S3 gallop Hepatomegaly
HJR/Increased JVP Ankle edema
Cardiomegaly Vital capacity decrease
Wt loss >4.5 kg 5d into >1/3 from max
Rx
SA Dysfunction
Atrial Fibrillation
First-Second degree AV block
Total AV Block
Left Bundle Branch Block
Right Bundle Branch Block
Ventricular Tachycardia
Ventricular Fibrillation
Komplikasi Ischemik
Perluasan Infark
Angina Post-infark
Komplikasi Emboli
Systemic embolism ;
stroke, limb ischemia, renal infarction,
intestinal ischemia
Komplikasi Inflamasi
Early Pericarditis
Late Pericarditis (Dresslers syndrome)
Primary PCI Case
CASE 2
CABG