CASE REPORT

D
NON-ST ELEVATION
MYOCARDIAL INFARCTION

PRESENTED BY :
QUINY KURNIA
C 1 11 1 1 1 7 1

SUPERVISOR :
DR.PENDRIK TANDEAN, SP.PD-KKV, FINASIM

D E PAR T M E N T O F C A R D I O L O G Y AN D VAS C U L A R
MEDICINE
M E D I C A L F AC U L T Y O F H A S A N U D D I N U N I V E R S I T Y
M AK AS S AR
2016
PATIENT IDENTITY

Name : Mr.N
Age : 33 y.o
Address : Makassar
MR : 740326
Date of Admission : January 8th 2016
HISTORY TAKING

Chief complaint : Chest pain

Present Illness History :
Left chest pain felt since 24 hours ago before admission
Occurs suddenly when the patient was resting
Described as oppressed pain and felt thru to the left arm
and jaw intermittently, duration of pain : 10 minutes.
HISTORY TAKING

Past Illness History :

History of chest pain since March 2015.
History of Hypertention denied
No history of diabetes melitus type II
HISTORY TAKING

Personal Life History :

No history of alcohol consumption
No history of smoking
History of consuming high calories diet
PHYSICAL EXAMINATION

General Status
Moderate illness / well nourished/ Composmentis
Weight: 55 kg
Height : 165
BMI : 20.2 kg/m2
Vital Status
Blood pressure :150/90 mmHg
Heart rate : 92 bpm
Respiratory rate : 26 rpm
Temperature : 36,5oC
PHYSICAL EXAMINATION

Head : anemic (-) icteric (-)

Neck : JVP R+0 cmH2O
Lung :
Inspection : symmetry left=right
Palpation : no tenderness, normal vocal fremity
Percussion : sonor
Auscultation : vesicular, ronchi -/- at basal lung,
wheezing -/-
PHYSICAL EXAMINATION

Cor :
Inspection : ictus cordis not visible
Palpation : ictus cordis not palpable, thrill (-)
Percussion :
Upper border 2nd ICS sinistra
Right border 4th ICS linea parasternalis dextra
Left border 5th ICS linea midclavicularis sinistra
Auscultation : heart sound I/II pure, regular, murmur (-)
PHYSICAL EXAMINATION

Abdomen :
Inspection : flat, follows breath movement
Auscultation : peristaltic (+), normal
Palpation : liver and spleen not palpable
Percussion : tympani

Extremities :
Edema (-)
ELECTROCARDIOGRAPHY

Sinus Rhytme HR:

98bpm
Regularity: regular
Axis : normoaxis
PR interval : 0.16
second
QRS rate : 0.12
second
ST segmen :
ST depresion on
Lead I, II, AVL, V3-
V6
Tall T on Lead I,
AVL, V1, V2
Conclusion :
Sinus tachycardi
Ischemic inferior and
anterolateral wall
LABORATORY RESULTS
TEST RESULT NORMAL TEST RESULT NORMAL
VALUE VALUE
WBC 10.8 x 103/uL 4.0 10.0 x 103 Tot.Choles 198mg/dl 200
HDL 42mg/dl >59

RBC 4,49 x 106/uL 4.0 6.0 x 106 LDL 168mg/dl 130

HGB 14.0 g/dL 12 16 Trigliserida 66 mg/dl 200
HCT 41% 37 48 Ureum 21 10-50
PLT 421 x 103/uL 150 400 x 103 Kreatinin 1,16 0,5-1,2
Troponin I 3.78 <0,01
PT 9.8 10 - 14 CK 598,00 <190
APTT 24.9 22,0 - 30,0
CKMB 40.5 <25
INR 1.0
Natrium 131 136 - 145
GDS 108 140
Kalium 3,9 3,5 - 5,1
Klorida 103 97 - 111
SGOT 60 u/L <38
SGPT 26 u/L <41 Asam Urat 6.8 3,4-7,0
DIAGNOSIS

Non-ST elevation Miokard Infark

Hypertension gr.I
Dyslipidemia
TREATMENT
Oksigen 2-4 liter per menit via nasal kanul
IVFD NaCl 0,9% 500 cc/24 jam/IV
Aspirin 160mg (loading dose) 80mg/24j/oral
Clopidogrel 300mg (loading dose) 75 mg/24 jam/oral

Isosorbid Dinitrat 1mg/jam/SP

Arixtra 2,5mg/24j/SC
Lasix 40mg/12jam/IV

Captopril 12.5mg/8jam/oral
Simvastatin 40 mg/24 jam/oral

Alprazolam 0,5mg/24jam/oral
Laxadyne syr 10ml/24jam/oral
DISCUSSION
 INTRODUCTION

Acute coronary
syndromes (ACS)
is a term for situations
where the blood supplied
to the heart muscle is
suddenly blocked.
described as a group of
conditions resulting from
acute myocardial
ischemia (insufficient
blood flow to heart
muscle)
PATOPHYSIOLOGY
WHO DIAGNOSTIC CRITERIA

Prolonged chest pain

Ischemic Usually retrosternal location
symptoms

Dyspnea
Diaphoresis

Diagnostic
ECG changes

Serum cardiac Troponin-T

CK-MB
marker CK
elevations Myoglobin
RISK FACTORS

Non-
Modifiable
Modifiable
Smoking
Gender & Age
Hypertension Men > 45 years old
Diabetes mellitus Women > 55 years old

Hypercholesterolemia
Family history
Obesity Heart disease in biological
brother or father > 55 years
Psychosocial stress old
Heart disease in biological
Lack of physical activity sister or mother > 65 years old
CARDIAC BIOMARKERS
GOAL OF TREATMENT

Hemodynamic
Relieve pain
stabilization

Myocardial Prevent the

reperfusionn complication
THANK YOU