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

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gre

vati

ng

, , ra

dia

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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.