Beruflich Dokumente
Kultur Dokumente
Injuries Cancer
(35%)
(28%)
Persentase
(%)
6,2
5,3
5
Hamm CW et al.
Mechanisms of thrombosis
7
Davies MJ. Heart
Miokard yang dapat diselamatkan dengan reperfusi
Lama Oklusi
Becker LC, Ambrosio G: Myocardial consequences of reperfusion, Prog Cardiovasc Dis 30:23-49,
1987
Options for Transport of Patients With STEMI
and Initial Reperfusion Treatment
Not PCI
capable
Golden Hour = first 60 min. Total ischemic time: within 120 min.
Antman EM, et al. J Am Coll Cardiol 2008. P9ublished ahead of print on December 10,
2007. Available at http://content.onlinejacc.org/cgi/content/full/j.jacc.2007.10.001.
Importance of GP role in ACS management
13
Hamm CW, et al. European Heart Journal (2011) 32, 29993054
Unstable Angina
Thrombosis caused by
disruption.
14
Davies MJ. Heart
Acute Myocardial Infarction
Thrombosis caused by
disruption. The cap of the
plaque has torn and thrombus
within the lipid
Core extends into and occludes
the lumen.
15
Davies MJ. Heart
Diagnosis
2. Diagnostic tools
- Physical examination
- EKG
- Biomarkers
- Imaging
18
Author | 00 Month Year
ECG
ST depression
T-wave inversion
Horizontal ST with
STT angulation
U-wave inversion
20
Jacobson C. AACN Advanced Critical
Acute Injury Patterns
ST elevation 1 mm or more
in 2 contiguous leads
Changes
< 1 mm - > 10 mm
ST resolves - anterior up to
2 weeks; posterior > 2 weeks
T wave : many months
22
Morris F, Brady WJ. BMJ
Localisation of site of infarction
23
Morris F, Brady WJ. BMJ
Biomarkers
25
Author | 00 Month Year
10/3/12
99th percentile of hs TnT assay
12
8
99th percentile of URL detection
of old TnT
6
assay
0
0.000 0.005 0.010 0.015 0.020 0.025 0.030 0.035 0.040
Troponin T ug/L
< 40 0 < 80 63 I 0
40 - 49 18 80 89 58 II 21
60 - 69 55 120 - 139 37 IV 64
70 - 79 73 140 - 159 26
80 91 160 - 199 11
> 200 0
34
Hamm CW, et al. European Heart Journal (2011) 32, 29993054
CRUSADE
Parameter
Baseline
haematocrit
Creatinine
clearance
Heart rate (b.p.m.)
Sex
Signs of CHF at
presentation
Prior vascular
disease
Diabetes mellitus
Systolic blood
pressure,
46
Hamm CW, et al. European Heart Journal (2011) 32, 29993054
STEMI Management
Prevention of delays is critical in STEMI
Treatment goals in STEMI management
Reperfusion therapy
52 1.Steg PG, et al. European Heart Journal. 2012;33:2569-2619 ; 2. Anderson JL, et al. Circulation. 2007;116:e148-e304.
Checklist of treatments when an ACS
diagnosis appears likely