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KEPANITERAAN KLINIK
ILMU KARDIOLOGI
FKUIN-RSUP FATMAWATI
JAKARTA 2016
HD (Heart Disease)
General term for a variety of heart conditions.
Most common form:
CHD or CAD
Coronary Arteries
Coronary Arteries
CAD: Etiology
Determinants of
Angina
ACUTE
CORONARY
SYNDROME
Angina Pectoris
tidak stabil (UAP)
Infark Miokard
tanpa ST Elevasi
(NSTEMI)
Infark Miokard
dengan ST
Elevasi (STEMI)
Biomarker
Troponin: begin to rise 3-4 hours after onset discomfort, peak 1836hr, decline slowly 10-14 days
CK : start to rise 3-8 hours, peak 24 hr, return to normal 48-72 hr
In-Hospital Care
Within the first 10 minutes that the patient is in the Emergency
Department, work through the following:
1.
2.
Evaluate O2 saturation
3.
Establish IV access
4.
5.
Look for risk factors of ACS, cardiac history, signs and symptoms of HF by taking a brief,
targeted history
6.
7.
8.
1.
2.
3.
Oxygen supplementation can be given to all patient with ACS in the first 6
hours, without consider the saturation
3.
Aspirin 160-320 mg sublingual can be given to all patient who doesnt have
intolerance with aspirin
4.
Therapy
REPERFUSION
PCI OR
Thrombolitic?
Keberhasilan reperfusi:
Nyeri dada berkurang
ST segmen normal
Puncak cardiac marker lebih cepat dari
seharusnya
STEMI
FIBRINOLYTIC THERAPY
COMPLICATION
Thank You
TUJUAN
TERAPI
Mengatasi
&
mencegah
serangan
akut
Pencegahan
jangka
panjang
serangan
angina
Meningkatkan
toleransi pasien
terhadap latihan
ANTI ANGINA
Nitrat
organik
NO
menstimula
si
guanilat
siklase
Kadar C
GMP
Defosforilasi
Isosorbid dinitrat
miosin
Nitrogliserin
Relaksasi
otot polos
Bloker
frekuensi,kontraktili
tas
dan
tekanan
darah
tegangan dinding
Cardioselective
ventrikel
Bisoprolol,
Mengurangi
suplai
Antagonis
kalsium
Metoprolol
oksigen miokard
Hambat
ion
masuk ke sel
Ca
Kronotropik
dan
inotropic negative
Verapamil,
Prioritas kardiologi
preventif
Referensi
Rhee JW, Sabatine MR, Lily LS. Et al. Atherosclerosis,
Ischemic Heart Disease, Acute Coronary Syndrome in
Pathophysiology of Heart Disease.. 2011
Nabel EG, Braundwald E. A tale of Coronary Artery
Disease and Myocardial Infarction in New England
Journal of Medicine. 2012
O Connor RE, Brady W, Brooks SC, et al. Acute
Coronary Syndrome: 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care. Circulation. 2010
2013 ACCF/AHA Guideline for the Management of STElevation Myocardial Infarction.
ESC Guidelines for the management of acute coronary
syndromes in patients presenting without persistent
ST-segment elevation. European Heart Journal. 2011
Myrtha R. Patofisiologi Sindrom Koroner Akut. CDK-192/
vol.39 no 4 th 2012
Congratulations
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