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Sanggam Sinambela, MD
ACUTE CORONARY SYNDROME
Definition :
Spectrum of ACS :
STEMI (ST elevation Myocardial Infarction)
NSTEMI (Non ST Elevation Myocardial Infarction)
UAP (Unstable Angina Pectoris)
ACC/AHA 2014 Guidelines NSTEACS.
Chest pain
ST elevation ST depression
ECG ST segment
Diagnosis
STEMI NSTEMI UA
3 Adapted from Hamm CW et al. Eur Heart J 2011;32:2999 – 3054
PATHOPHYSIOLOGY
Risk factors :
Non-modifiable
Gender
Age (for women : menopause, men : 10 years younger)
Family history
Modifiable
Smoking
Hypertension
Diabetes and metabolic syndrome
Abnormal serum lipid
Lack of physical exercise ESC Textbook of Cardiovascular Medicine, p.335-337
PATHOPHYSIOLOGY
• Older patients,
• Women,
• Diabetic
• Prior heart failure
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ECG CHANGES OF INJURY ACUTE MYOCARDIAL INFARCTION
Changes
< 1 mm - > 10 mm
(NSTEMI or U.A.P)
CLINICAL FEATURES
CLINICAL
FEATURES
Causes
of chest pain
Tindakan selanjutnya ?
Dokter bekerja di salah satu RS di
Sukabumi, yang ada SpJP
Perempuan 79 tahun, sesak napas berat, disertai keringat dingin
Tindakan selanjutnya ?
Tindakan selanjutnya ?
Dokter bekerja di RS di Depok
Tindakan selanjutnya ?
Onset of STEMI Hospital Management Modified from Libby. Circulation 2001;104:365,
- Prehospital issues - Medications Hamm et al. The Lancet 2001;358:1533 and
- Initial recognition and management - Arrhythmias Davies. Heart 2000;83:361.
in the Emergency Department (ED) - Complications
- Reperfusion - Preparation for discharge
Secondary Prevention/
Management Long-Term Management
Before STEMI
Chronology of the
interface between the
1 2 3 4 5 6 patient and the
4 clinician through the
progression of plaque
Presentation
Ischemic Discomfort
formation and the
Acute Coronary Syndrome
Working Dx
onset of complications
ECG No ST Elevation ST Elevation
of STEMI.
UA NSTEMI
Cardiac
Biomarker