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Kelompok 4

Eileen Euides
Handry Baso P.M
Indah P.Rauf
Rizcky Naldy Eka P.
Maulida Arini
Kevyn R. W.P.
Sitti Inas Stassia
Reska Perdana
Agung Jaya N.
Lady Manga P.
Skenario 2
Futsal Tragedy
Mr.Adji, 40 years old rushed of to the hospital because
complaining of sudden dyspnea since 30 minutes ago and
his chest became pressing something, before he had
finished playing futsal. Mr.Adji also felt chest pain that
spreads to the neck and arms and had vomited once.
From doctor examination, find Blood pressure
170/100mmHg, pulse 110x/minutes, and breath frequency
28x/minutes. Total cholesterol 320mg/dl. CKMB 30 U/I.
EKG showed depression ST segmen. The doctor gave
oxygen and sublingual isosorbid dinitrat and cured Mr.Adji
at CVCU.
ANATOMY

•Position,Border
•Viewed
•Valve
PHYSIOLOGY

HEART CIRCULATION
HEART CONDUCTION
Work Diagnostic

Acute Coronary Syndrome

WHY?
DEFINITION:
Acute Coronary Syndrome is combination of clinical
symptoms indicating acute myocardial ischemia, consist of
ST-segment elevation (ST segment elevation myocardial
infarction = STEMI), acute myocardial infarction without ST
segment elevation (non-ST elevation myocardial infarction
segemnt = NSTEMI), and Unstable Angina Pectoris =
UAP.

ACUTE CORONARY SYNDROME

MYOCARD INFARCTION UNSTABLE ANGINA


PECTORIS

STEMI NSTEMI
Epidemiology:
•1st sudden death in America
• Mostly in white race,
• Estimated 2 million people in America incresing
rick factor of ACS and death
Patophysiology
Endotel dysfunction
:from Risk factor 
endotel  plaque 
atherosclerosis
Clinical Manifestation:
• Chest pain, such as burn, pressure
• Referred pain to left arm or mandibula/
maxilla
• Naussea
• Vommiting
• Dyspnea
Find diagnostic:
• History taking : chest pain
• Physical examination : rarely find specific symptom,
Pulmonary edema and other signs of left heart failure
- Extracardiac vascular disease
- Jugular venous distension
- Cool, clammy skin and diaphoresis in patient with cardiogenic
shoch
• Additional examination
EKG : depression of ST Segment,normal
Laboratory : CKMB, Total cholesterol,LDL
Chest X Ray : infiltrat
High Risk Low Risk

Diagnosis STEMI NSTEMI UAP

Treatment Reperfusi Invasive Non-invasif


Myocardial Infarction
• Cardial chest pain
• Change in ECG before and after monitor
(pre hospital and hospital)
• Elevated cardiac enzyme (CKMB)

* MI standed if there are 2 of 3 point above


Management : • Pre hospital (MONA)
Hospital
- Pharmacology
Oxygenated
Revascularisation
- Non pharmacology
PTCA,CABG

Post Hospital
- Controll intake (low cholesterol)
- Stop smoking
- Exercise (jogging,swimming,cycling)
Complication
Complications of ischemia include
pulmonary edema, while those of myocardial
infarction include rupture of the papillary
muscle, left ventricular free wall, and
ventricular septum.
Prognostic
25% death before arrived at hospital
Mortality total 15-30%
Mortality at <50 years 10-20%
Mortalitity at > 50 tahun 20%
References:
• American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science
http://circ.ahajournals.org/content/122/18_suppl_3/S78
7.full
• Brashers, VL, 2008, aplikasi klinis patofisiologi :
pemeriksaan dan manajemen, edisi II, EGC, jakarta
• Davey, P, 2005, at a glance medicine, erlangga,
jakarta
Stary HC, et al. Circulation. 1995;92:1355-74. Artery
wall often gets larger with increasing plaque-Glagov
NEJM 1987
THANK YOU