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Topics
Angina Pectoris and Accompanied
symptoms
Physical Examination
ECG
Laboratory finding
Treatment
ACS Algorithm
2
Chief Complaint
Chest Pain
Angina Equivalent
Accompanied symptom ?; associated
with cardiac function
Angina Pectoris
A syndrome resulting from myocardial
ischemia
Demand and supply imbalance
Careful history taking; risk factor, activity
/stress-induced pain, location,character of
pain, duration, etc
Spectrum Of ACS
Topics
Angina Pectoris and Accompanied
symptoms
Physical Examination
ECG
Laboratory finding
Treatment
ACS Algorithm
7
Physical Examination
Alert-Unconscious
BP: Hypertension-Normal-Hypoptension
HR: Regular-irregular/ Bradycardia-Tachycardia
pulseless
RR: Tachypnea-apnea
Cor: Regular-iregular, murmur, gallop
Pulmo: Normal-Rales- wheezing
Ext: cold, pulsation, edema, etc.
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Topics
Angina Pectoris and Accompanied
symptoms
Physical Examination
ECG
Laboratory finding
Treatment
ACS Algorithm
9
UAP/Acute NSTEMI
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Acute NSTEMI
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LOKASI ISKEMIA
BERDASARKAN PERUBAHAN DI SANDAPAN EKG
SANDAPAN
II ,III, aVF
V1,V2
V3-V4
V1-V6, I, aVL
I,aVL ,V5,V6
I, V6
V7-V9
V3R, V4R
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Inferior STEMI
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LBBB
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RBBB
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Topics
Angina Pectoris and Accompanied
symptoms
Physical Examination
ECG
Laboratory finding
Treatment
ACS Algorithm
21
22
Topics
Angina Pectoris and Accompanied
symptoms
Physical Examination
ECG
Laboratory finding
Treatment
ACS Algorithm
23
Treatment of ACS
Treat the emergency condition;
complication of ACS; asystole, apneu,
syock, acute lung edema, etc
Confirm the diagnosis
Treat the cause
Treat co-morbid
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Emergency Department
(1)
AMI Protocol
-ECG screening within 10 minutes
-Door-to-drug time < 30 minutes
-Door-to-balloon time inflation < 90
minutes
For all patients with ischemic-type chest
pain, provide supplementary oxygen, IV
access, and continuous ECG monitoring
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Emergency Department
(2)
Reperfusion therapy for ST-segment
elevation MI (STEMI)
- Rule out contraindications and
assess risk-benefit ratio
-Consider PCI if ineligible for
fibrinolytics
-angiography for cardiogenic shock
(angioplasty or CABG if indicated)
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Cautions/Relative Contraindications
Previous hemorrhagic
Ischemic strokes 3 mo
( except 3 hrs )
Known intracranial
malignant neoplasm
PCI
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Topics
Angina Pectoris and Accompanied
symptoms
Physical Examination
ECG
Laboratory finding
Treatment
ACS Algorithm
32
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Thank You
35