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Культура Документы
Problems Solutions
• Prolonged ED • Consensus definition
Evaluation • Validated Clinical
• Unnecessary admission Decision Rules
• Safe discharge – missed • Evidence Based
dx < 1% Medicine
• Cost
Epigastric Back
Atypical Chest Pain
• Atypical presentations include epigastric pain, indigestion-like
symptoms and isolated dyspnoea
• Atypical complaints are more often observed in
the elderly, in women and in patients with diabetes, chronic renal
disease or dementia.
• The exacerbation of symptoms by physical exertion and their
relief at rest increase the probability of myocardial ischaemia
Indonesia ?
Angina Pectoris
Typical Unstable
JAMA. 2015;314(18):1955-1965
2015;314(18):1955-1965.
Clinical Scenario
Clinical Scenario
Discussion
JAMA. 2015;314(18):1955-1965
Single Parameter First Question
Outline
Emergency Department :
• Symptoms of Ischemia ( Acute Vs Stable )
• Angina Equivalent & Associated Symptoms ( Risk factors )
• Ruling in & Ruling Out Acute Coronary Syndrome
• Heart Score & Probability
Acute Coronary Syndrome :
• The Spectrum
• Time is Muscle & Survival
• Team Approach
• Safe Referral System : PCI Capable Centre
Pitfalls & Problems
• Challenging ECG
• Initial Tx : One may not fits all
• ACLS & ACS
Take Home Messages
CAD Clinical Spectrum
Asymptomatic
Prinzmetal Angina
Stable Angina
Unstable Angina
Myocardial Infarction
Heart Failure
Syncope
Sudden Death
n engl j med 376;21 nejm.org May 25, 2017
European Heart Journal (2018) 00, 1–33
European Heart Journal (2018) 00, 1–33
IRD Acute Cardiac Care ICCU Cath Labs
Outline
Emergency Department :
• Symptoms of Ischemia ( Acute Vs Stable )
• Angina Equivalent & Associated Symptoms ( Risk factors )
• Ruling in & Ruling Out Acute Coronary Syndrome
• Heart Score & Probability
Acute Coronary Syndrome :
• The Spectrum
• Time is Muscle & Survival
• Team Approach
• Safe Referral System : PCI Capable Centre
Pitfalls & Problems
• Challenging ECG
• ACLS & ACS
• Initial Tx : One may not fits all
Take Home Messages
STEMI
Challenging ECG
NSTEACS
NSTEMI Treatment Strategy and Timing According to Risk Stratification1
41
Risk Criteria Mandating Invasive Strategy in NSTE-ACS1
42
• Fluid Resuscitation as needed
• Lasix for ove
• Norepinephrine for cardiogenic shock w/ severe
hypotension
• Inotropes for predominant low cardiac output
• Report
How to Report
• Male/46
• STEMI Anterior Onset 3 hours
• VS : 120/70 mmHg/105x/28x/afebris/96% O2 Nasal
• Ronkhi +/Murmur (-)
• IV Line NS/Aspirin 300/Plavix 300/Lasix 2 amp
• Risk factors : Smoking