Acute Heart Failure in

Acute coronary Syndrome :

buying time to revascularization

Dyah Siswanti MD
PJK di Eropa 1,8 juta kematian / tahun
(20% all mortality )

STEMI 43 – 144 / 100.000/ thn (2015)

in hospital mortality 4 – 12%

USA 50/100.000/thn ( 2008 )

Canadian Cardiovascular Association Classification of
Angina

CLASS 1 NO PAIN WITH ORDINARY PHYSICAL ACTIVITY

CLASS 2 SLIGHT LIMITATION OF PHYSICAL ACTIVITY,

PAIN OCCSRs WITH WALKING, CLIMBING
STAIRS, STRESS

CLASS 3 SEVERE LIMITATIONS OF DAILY ACTIVITY -

PAIN OCCURS ON MINIMAL EXCERCION

CLASS 4 UNABLE TO CONDUCT ANY ACTIVITY

WITHOUT PAIN, PAIN AT REST
Canadian Cardiovascular Association Classification of
Angina

CLASS 1 NO PAIN WITH ORDINARY PHYSICAL ACTIVITY

CLASS 2 SLIGHT LIMITATION OF PHYSICAL ACTIVITY,

PAIN OCCSRs WITH WALKING, CLIMBING
STAIRS, STRESS

CLASS 3 SEVERE LIMITATIONS OF DAILY ACTIVITY -

PAIN OCCURS ON MINIMAL EXCERCION

CLASS 4 UNABLE TO CONDUCT ANY ACTIVITY

WITHOUT PAIN, PAIN AT REST
 Acute Myocardial Infarction

⚫ ECC/ACC – rise and fall in cardiac enzymes

with one or more of the following:

⚫ Ischaemic type chest pain/symptoms

⚫ ECG changes – ST changes, pathological Q
waves
⚫ Coronary artery intervention data
⚫ Pathological findings of an acute MI
Possible non-acute coronary syndrome
causes of troponin elevation
 STEMI
EKG :
ST elevasi > 2.5 mm in men < 40 years,
> 2 mm in men > 40years,
or
1.5mm in women in leads V2–V3
and/or > 1mm in the other leads (in the absence of left
ventricular hypertrophy or left bundle branch block
LBBB).

Multivessel/LM disease : ST depression > 1 mm in six or

more surface leads (inferolateral ST depression), coupled
with ST-segment elevation in aVR and/or V1
STEMI
Recommendation for reperfusion therapy
How about NSTEMI
 NSTEACS Management
Immediate invasive
Very High Risk
(< 2hr)

Early invasive
High Risk
(<24hr)

Intermediate Invasive
risk (<72hr)

Low risk Selective invasive

strategy
Roffi M et al. European Heart Journal 2015. doi:10.1093/eurheartj/ehv320
 Komplikasi

GAGAL JANTUNG AKUT

ARITMIA
INTERVENTRIKULAR SEPTAL RUPTUR
MITRAL REGURGITASI AKUT
SYOK KARDIOGENIK
Acute heart Failure
Causes of elevated concentrations
of natriuretic peptides
Diagnostic measurements in AHF
Clinical profiles of patients with acute heart failure based
on the presence/absence of congestion and/or
hypoperfusion
Positive inotropes and/or vasopressors
used to treat acute heart failure
Intravenous vasodilators for AHF
Oxygen therapy and ventilatory
support in AHF
 Conclusion
⚫ Ischaemic heart disease worldwide is the single
most common cause of death and its frequency is
increasing.
⚫ Management of ischemic heart disease – including
diagnosis and treatment – as early as first medical
contact will give more benefit for patient in short and
long term prognosis.
⚫ Reperfusion therapy especially invasive therapy
makes difference in mortality for STEMI and high risk
NSTEMI .
⚫ Treatment of complication and long term medication
in ischaemic heart disease patient can impact overall
results
Thank you
 GRACE Risk Model Nomogram

To convert serum creatinine level to micromoles per liter, multiply by 88.4.

 TIMI Risk Score* for NSTE-ACS
TIMI Risk All-Cause Mortality, New or Recurrent MI, or
Score Severe Recurrent Ischemia Requiring Urgent
Revascularization Through 14 d After
Randomization, %

0–1 4.7
2 8.3
3 13.2
4 19.9
5 26.2
6–7 40.9
*The TIMI risk score is determined by the sum of the presence of 7
variables at admission; 1 point is given for each of the following variables:
≥65 y of age; ≥3 risk factors for CAD; prior coronary stenosis ≥50%; ST
deviation on ECG; ≥2 anginal events in prior 24 h; use of aspirin in prior 7
d; and elevated cardiac biomarkers.