More Related Content
Similar to Case-Report stemi lateral pada jantung dan pembuluh darah (20)
Recently uploaded (20)
Case-Report stemi lateral pada jantung dan pembuluh darah
- 1. CASE REPORT STEMI LATERAL By : Cut Rully Marvita Supervisor : Dr. Nurkhalis, Sp. JP FIHA
- 2. Identity Nama : Mr. Z Age : 54 years old Gender : Male Religion : Islam Ethnic : Aceh Occupation : Mechanic Address: Lampulo Addmision : January 3rd 2013 Examination date : January 6th 2013
- 4. History of Present Illness patients present with complaints of chest pain that is felt spreading to the left arm and lower jaw. Chest pain is also felt through to the back of the body. Patients may also experience bloating which suppresses the chest and stomach. This complaint is felt 4 hours before admission to the hospital. The patient also complained of shortness of breath at the time of chest pain.
- 5. History of previous illness A year ago, the patient had been treated with the similar complaint History of drug use Data treatment for patients admitted to have been lost. Previously, patients taking medications that are given from the hospital, the patient no longer taking medication when the patient felt himself cured. History of family disease His mother had hypertension History of patients social customs Patients smoked since the age of 10 years, for 30 years the patient smoked about 2 packs of cigarettes a day
- 6. Unmodified Risk Factors Male age above 40 years Modified Risk Factor Smoking Cigarettes
- 7. Status Present General Condition : Moderate Consciousness : Compos Mentis Blood Pressure: 110/70 mmHg Heart Rate : 80x/menit, reguler Respiratory Rate : 24x/menit Temperature : 36,60 C Status General Skin Colour : Brown Turgor : quick return Ikterus : (-) Anemia : (-) Sianosis : (-) Oedema : (-) Head Shape : Normocepali Hair : Black Eyes : Light Reflection (+/+), Pale inf. Palpebra Conjungtiva (-/-)
- 8. Leher TVJ : R賊2 cmH2O swollen lymph nodes : negative Thorax Inspection Shape and Motion : Normochest, Symetric movement Respiration Type : Thorako-abdominal Retraction : (-) Palpation Strem femitus : Same in both part of the lung Percussion : Same in both part of the lung Auskultation : Ves (+/+), additional sound (-)
- 9. COR Inspection : Ictus Cordis not visible Palpation : Ictus Cordis perceived on ICS V LMCS. Percussion : Heart barier Top : on ICS III Right: on ICS V LPSD Left : on ICS V LMCS Auscultation : BJ I>BJ II, reguler, noisy (-) ABDOMEN Inspection : Symmetric, Distensi (-) Palpation : Soepel (+), Nyeri tekan (-) Hepar dan ginjal tidak teraba Percussion : Tympani (+), Asites (-) Auscultation : Peristaltik usus (N) Extermitas edema : (-)
- 10. Laboratory Results ( January 4th 2013 ) Examination Result Hb 13,5 Leukosit 15,7 Trombosit 189 LED 6 Hematokrit 36 Ct 9 Bt 3 Total bilirubin 0,78 Bilirubin direct 0,68 Bilirubin indirect - SGOT 346 SGPT 32 Alkali 130 Result Globulin 2,6 Ureum 25 Creatinin 0,8 GDN 101 Total cholesterol 285 Trigliserida 102 Asam Urat 2,9 HbsAg Negative
- 11. Electrocardiografi (Januari 3rd 2013) ECG Interpretation Rhtm : Sinus Heart Rate : 86x/ menit, regular Axis : normoaxis Interval PR : 0,16 sec Regularitas : reguler P wave : 0,08 detik QRS Complex: 0,10 detik LVH : - RVH : - ST elevasi : Lead I, II, AVL, V1, V5 dan V6 ST depresi : - Q patologis : III, AVF, V2, V3 dan V4 T inverted : - VES : - Interpretasi : STEMI Lateral Kesan : Abnormal EKG
- 12. Thorak x-ray (January 3rd 2013) X-ray Interpretation Cor :enlarged by 55% CTR, no hypertension configuration overview costophrenicus and cardiophrenicus both are sharp. Pulmo : cephalisasi (+), Infiltration (-) Conclusion : Kardiomegali and Oedem pulmonal
- 13. Diagnosis STEMI Lateral onset > 3 jam Killip I TIMI RISK 4/14 GRACE skor 152
- 14. Treatment General Bed rest Heart diet1600 kkal/day Spesific IVFD RL 10 gtt/i Drip Streptase 1500000 IU in 1 hr Lovenox 0,6cc/12hr Aspilet 320 mg (loading dose) Maintanance dose: 1x80mg CPG 300 mg (loading dose) Maintanance dose: 1x75mg Simvastatin 1x 20mg Drip Cedocard mulai 5 meq/kgbb/hr Sucralfat syr 1xCI Laxadin Syr 3xCI
- 15. Diagnostic Planning Serial ECG Complete blood laboratory test CKMB test Corangiography Prognosis Quo ad Vitam : Dubia ad bonam Quo ad Functionam : Dubia ad malam Quo ad Sanactionam : Dubia ad malam
- 16. SINDROMA KORONER AKUT Miocard Infarction in pathology as myocardial cell death due to prolonged ischemia. Without ST elevation (UAP / Non STEMI) With ST elevation (STEMI)
- 17. Different stages of atherosclerotic plaque development
- 19. Clinical Manifestation Chest pain lasting for 2o min or more, not responding to nytroglicerine. Important clue are a history of CAD and radiation of the pain to the neck, lower jaw or left arm. ST segment elevation in acute myocardial infarction should be found in two countiguous lead and be 0,25 mV Biomarker test such as troponin and CKMB
- 20. Chest Pain Admision Diagnosis Kerja ECG Bio- chemistry Diagnosis Pengobatan Acute Coronary Syndrome Persistent ST Elevation ST/T- abnormalities Normal atau Tdk dpt ditentukan ECG ESC 2007 STEMI NSTEMI Angina tidak stabil Reperfusi Fibrinolitik / PCI Invasive Non-Invasive Troponin rise/fall Troponin normal
- 22. STEMI Diagnosis Coronary Angiography Rescue PCI Primary PCI PCI Possible < 120 min? EMS or Non Primary PCI Capable Center Primary PCI Capable Center Successfull FIbrinolysis Immediate Fibrynolysis YES NO YES NO Preferably 3-24h Preferably 90 min ( 60 min in early presenters Preferably < 60 min
- 23. Treatment Reperfusion therapy - PCI (Percutaneus Chateter Intervention) - Pharmacotherapy (Aspirin and ADP) - Fibrinolisys Long term therapy - Aspirin - Beta blocker - Lipid lowering therapy - Nitrates - Calcium antagonist - ACE Inhibitor - Aldosteron antagonist