LAPORAN KASUSACS ec UAP
Pembimbing: Prof. Dr. T. Bahri Anwar Sp. JP (K)
Disediakan oleh: SHALINA KAUR 060100313 V.SATHIAS SUNDARI 060100316
Penyakit jantung koroner
• adalah penyakit jantung yang disebabkan oleh kelainan pembuluh darah koroner.
• Salah satu penyebab utamanya adalah aterosklerosis koroner yaitu proses penimbunan lemak dan jaringan fibrin
• Ini menyebabkan gangguan fungsi dan struktur pembuluh darah
• Seterusnya mengakibatkan berkurangnya aliran darah ke miokard.
• Kadar kolestrol darah yang tinggi
• Tekanan darah tinggi • Merokok • Obesitas • Berkurangnya
aktivitas
Faktor resiko TIDAK DAPAT DIMODIFIKASI
DAPAT DIMODIFIKASI
USIA
JENIS KELAMIN
GENETIK
DYSLIPIDEMIAHIPERTENSIMEROKOKDMOBESITASALKOHOLKURANG OLAHRAGA
Pathofisiologi
Unstable Angina STEMI NSTEMI
Non occlusive thrombus
Non specific ECG
Normal cardiac enzymes
Occluding thrombus sufficient to cause tissue damage & mild myocardial necrosis
ST depression +/- T wave inversion on ECG
Elevated cardiac enzymes
Complete thrombus occlusion
ST elevations on ECG or new LBBB
Elevated cardiac enzymes
More severe symptoms
Angina tidak stabil • Definisi apabila dikeluhkan :1. keluhan dengan angina masih baru dalam 2
bulan dimana angina cukup berat dan frekuensi cukup sering lebih dari 3 kali per hari.
2. pasien dengan angina yang makin bertambah berat, sebelumnya angina stabil lalu serangan angina timbul lebih sering dan lebih berat sakit dadanya sedangkan faktor presipitasinya berkurang.
3. pasien dengan serangan angina pada waktu istirehat.
anamnesa anamnesa
loca
tion
loca
tion
onsetonset
Ag
reva
tin
gA
gre
vati
ng
, , ra
dia
tio
nra
dia
tio
n
ConditionCondition
duration
duration
> Dari 20 minit
retroternal atau sedikit di kirinya
tertindih/berat di dada, rasa desakan yang kuat dari dalam atau dari bawah diafragma, diremas-remas , panas
aktivitas ,stres fisik ataupun emosional . Tidak berkurang dengan aktifitas atau nitrate SL
Saat beraktivitas maupun beristirehat
TIMI Risk ScorePredicts risk of death, new/recurrent MI, need
for urgent revascularization within 14 days
Diagnosis
Chest pain suggestive of ischemia
– 12 lead ECG– Obtain initial
cardiac enzymes
– electrolytes, lipids, bun/cr, glucose
– CXR
Immediate assessment within 10 Minutes
– Establish diagnosis
– Read ECG– Identify
complications– Assess for
reperfusion
Initial Initial labslabs
and testsand tests
Emergent Emergent carecare
History History & &
PhysicalPhysical– IV access– Cardiac
monitoring– Oxygen– Aspirin– Nitrates– morphine
ECG assessment
ST Elevation or new LBBBST Elevation or new LBBBSTEMISTEMI
Non-specific ECGNon-specific ECGUnstable AnginaUnstable Angina
ST Depression or dynamicST Depression or dynamicT wave inversionsT wave inversions
NSTEMINSTEMI
Diagnosis lain
StressStressTestTest
measures
measures
bloo
dbl
ood
supplysupply
to h
eart
to h
eart
CoronaryCoronaryAngiographyAngiography
spec
ific
spec
ific
showsshows
Co
ron
er a
rter
ies
Co
ron
er a
rter
ies
NarrowinginNarrowingin
Sites of
Sites of
•Blood tests: used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia.
•Chest X-ray: shows the size of your heart and whether there is fluid build up around the heart and lungs.
•Echocardiogram: shows a graphic outline of the heart’s movement
•Ejection fraction (EF): determines how well your heart pumps with each beat.
MANAGEMENT
• Goal of therapy :- improvement of symptoms- prevent rupture of plaque- prevent growth of plaque
• Risk factor modification
RISK FACTORS
MODIFICATION
SMOKINGDMHYPERTENSIONDYSLIPIDEMIA
LACK OF EXERCISEOBESE
ALCOHOL
CEASE / STOPCONTROLCONTROLLDL <100mg/dlHDL >35mg/dlROUTINE EXERCISELOSE WEIGHT –
DIET, EXERCISELIMIT ONLY 2
GLASS/DAY
PENGOBATANTirah baring, Oksigen 2-4L/i, analgesik
opiat, anti iskemik dan anti trombotik.
Anti iskemik termasuk nitrogliserin buccal, blocker, Ca Antagonis.
Anti trombotik : aspirin, clopidogrel, unfractionated heparin iv atau LMWH, dan Glycoprotein IIb/IIIa inhibitor.
Diet rendah garam
Invasive theraphies Angioplasty Bypass surgery
Medication Checklist after ACS
• Antiplatelet agent– Aspirin* and/or Clopidorgrel
• Lipid lowering agent– Statin
• Antihypertensive agent– Beta blocker– ACE-I/ARB– Aldactone (as appropriate)
•Get regular medical checkups.
•Control your blood pressure.
•Check your cholesterol.
•Don’t smoke.
•Exercise regularly.
•Maintain a healthy weight.
•Eat a heart-healthy diet.
•Manage stress.