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Acute Coronary Syndrome (Sindroma Koroner Akut) : Zulfikri Mukhtar

This document discusses acute coronary syndrome (ACS) and its types, including unstable angina pectoris (UAP), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). It covers risk factors, the pathophysiology of atherosclerosis and plaque formation, typical symptoms, diagnostic criteria, and emergency management strategies for ACS, including medications, monitoring, and percutaneous coronary intervention (PCI).

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Wina Desky
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65 views32 pages

Acute Coronary Syndrome (Sindroma Koroner Akut) : Zulfikri Mukhtar

This document discusses acute coronary syndrome (ACS) and its types, including unstable angina pectoris (UAP), non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). It covers risk factors, the pathophysiology of atherosclerosis and plaque formation, typical symptoms, diagnostic criteria, and emergency management strategies for ACS, including medications, monitoring, and percutaneous coronary intervention (PCI).

Uploaded by

Wina Desky
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Acute Coronary Syndrome

(Sindroma Koroner Akut)

Zulfikri Mukhtar
Kapan Atherosklerosis Terja
Atherosklerosis
Berawal dari usia
balita sampai dengan
lansia

Tedjasukmana P
FAKTOR RESIKO PJK

TIDAK DAPAT DI DAPAT DI


INTERVENSI INTERVENSI
Usia > 40 thn (lk) MEROKOK
Pr : Menopause HIPERTENSI
Jenis kelamin DIABETES
Riwayat Keluarga HIPERKOLESTEROL
PJK : Penyakit Jantung Koroner
PLAK ATEROsklerOSIS
Adalah deposit dari :
 KOLESTEROL (UTAMA)
 KALSIUM
 JARINGAN IKAT
 OTOT POLOS
 KOMPONEN DARAH
 FIBRIN
 KARBOHIDRAT
Coronary Heart Disease :

1.Stable Angina Pectoris


2.Unstable Angina Pectoris
3.Non-ST Segment Elevation Myocardial
Infarction
4.ST Segment Elevation
Myocardial Infarction
5.Suddent Cardiac Death
Acute Coronary Syndrome
Dimana Rasa Nyeri Dirasakan??
Acute Myocardial infarction
WHO :
1.Clinical symptom : angina pain > 20 minutes
(typical infarct pain).
2. ECG changes (ST-T changes or new LBBB).
3. Laboratorium : increase cardiac enzyme
(SGOT, LDH, CPK – standard – 4 h from onset)
CKMB, Troponin T (1 h from onset) ( 2 of 3
criteria).
Unstable Angina Pectoris

Diagnosis :
1.Typical angina > 20 minutes
2.Finds ECG changes ( ST segment depression
or T wave inversion)
3.No increase cardiac enzyme
NSTEMI
(non ST segment elevation myocardial infarction –
Non Q wave infarction )

1. Typical angina pain > 20 minutes


2. ST-T changes (ST segment depression or T
wave inversion)
3. Elevated cardiac enzyme
STEMI
(ST segment elevation myocardial infarction)

1. Typical angina pain > 20 minutes


2. ECG changes : ST segment elevation.
3. Increase cardiac enzyme
STEMI

1. Inferior wall ( limb lead ;lead II, III, aVF 


2 of 3 ) ST elevation : 1 mV.

2. Anterior wall ( Precordial lead; V1 – V6 )


ST elevation : minimal 2 mV.
ST Elevation Myocardial Infarction
Spectrum ACS
Acute coronary syndrome

No ST elevation ST elevation

No enzyme enzyme
Rise rise

UAP NQ- MI Qw MI
NSTEMI
Management ACS

Emergency ward.
1.Oxygen 2 – 3 l /m
2.IV line
3.Nitrate 5 mg sublingual.
4.Killing pain : Morphin 2,5 – 5 mg (Dilute, IV,
if HR > 90 x / m. Pethidine 25 – 50 mg (Dilute,
IV, if HR < 90 x /m).
Management ACS
Emergency ward.
5. Clopidogrel (75 mg/tab) : 600 mg (onset 2
hours) ; 300 mg (onset 4 hours), 75 mg/d
Aspirin : 300 mg (enteric coated- chewed)
80 , 100 , 0r 160 mg /d
Anticoagulant :
-UFH (unfractionated heparin) : bolus
5000 units, maintenance 750 – 1000 U/h
Controle :aPTT 2 – 3 normal.
Management ACS
Emergency ward.
5. - LMWH.
=Enoxaparine or dalteparine ( Porcine) 100 U/
kg, twice daily or 60 mg / 12 h)
=Fondafarinux (synthetic) 2,5 mg /d

-> care in ICCU / ICU ward.


Management ACS
ICCU / ICU ward.
5. Nitrate intravenous
- ISDN (isosorbide dinitrate ) 1-2 mg /h
(syringe pump 10 mg or 1amp/50 cc)
- Nitroglycrine : 10 – 200 micro U/ m
(Nitrocine 10 mg / 50 cc-syringe pump)
Management ACS
ICCU / ICU ward.
5. Statin (all statin).
If necessary ( heart failure  diuretic).
Anterior wall infarct ( beta blocker , ACE
inhibitor).
Thrombolytic ( if STEMI anterior wall ,
onset symptom< 12 hours)
1.
Primary Angioplasty (PCI)
The current gold standard reperfusion of
STEMI
STEMI onset of symptom < 12 h, more benefit
< 6 hours.
The necessary backup : Suction thrombus,
TPM, IABP.
Drug : Gp II b / IIIa.
Open : infarct related artery only.

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