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Introduction

SINDROM KORONER AKUT

Partial disturbance of total coronary blood flow


to the myocardium (Rilantono, 2015).

Causes High hospital care rates and mortality

(PERKI, 2015; Rilantono, 2015).


Atherosclerotic plaques form in the
coronary arteries  narrowed artery 
blood flow to the heart muscle ↓

If one of the plaques escapes, then the


blood clot can clog the flow in the
coronary arteries

Cardiac muscle does not get blood


supply, O2 and very little or no nutrients

(Naik et al., 2011).


SKA
STEMI NSTEMI UAP
(Non ST
(ST Elevation (unstable
Elevation
Myocardial angina
Myocardial
Infarction) pectoris)
Infarction)
Literature review
epidemiology

• AMI is most severe manifestation of CAD, causes 2,4 million deaths in


USA dan more than 4 million deaths in Europe and northern Asia,
(Nicholas, 2014) and more than a third of deaths in developed
nations annually (Yeh, 2010).
• Since the mid-1990s there has been a steady decline in the
proportion of patients with ST-segment elevation myocardial
infarction (STEMI), and a smaller increase in non-STEMI (NSTEMI),
leading to an overall decline in myocardial infarction (Yeh, 2010)
Pathophysiology
Pathophysiology
MANIFESTASI KLINIS

• ANAMNESIS
In anamnesis found patient complaints with chest pain that besifat typical and
the fator risk

Diagnosis of SKA becomes stronger if the complaint is found in patients with


the following characteristics:
• Male
• Known to have non-coronary atherosclerosis (peripheral / carotid artery
disease)
• It is known to have CHD on the basis of having had myocardial infarction,
coronary bypass surgery, or PCI
• Have risk factors: age, hypertension, smoking, dyslipidemia, diabetes
mellitus, family history of early CHD, classified for high risk, moderate risk,
low risk according to NCEP (National Cholesterol Education Program)
PHYSICAL EXAMINATION

Physical examination is performed to identify trigger factors of


ischemia, complications of ischaemia, comorbidities and exclusion of
differential diagnoses. Acute mitral valve regurgitation, three heart
sounds (S3), wet smooth rhizomes and hypotension should always be
examined to identify ischemic complications.
Supporting Examination - ECG
Supporting Examination - ECG
Examination of the heart marker
Supporting Examination

• Lab Check
Includes: routine blood tests, blood glucose in time, electrolyte status,
blood coagulation, kidney function tests, and lipid panel
• X rays
Infark miokard

Unstable Angina NSTEMI STEMI

Typical symptoms Crescendo, at rest, severe Chest pain dull the old, heavier and wider spread than
chest pain when it first ordinary chest pain
appears

Serum biomarker (-) (+) (+)

Early ECG ST depression and / or T ST depression and / or T ST elevation (and Q wave


wave inversion wave inversion later)
TATA LAKSANA

• Initial therapy in angina: Morphine, Oxygen, Nitrate, Aspirin (MONA


abbreviated)
• Corrective Percutaneous Corrugation Primer (primary PCI)
• Medicamentous or fibrinolytic reperfusion therapy
• Post-reperfusion medical therapy
• Surgical therapy
• Long-term therapy
KOMPLIKASI

• Heart failure
Hemodynamic • Arrhythmias (supraventricular,
ventricular, block)
Disorders

• MR
Cardiac • Heart Rupture
• Rupture of the ventricular septum
Complications • Ventricular infarction
• Pericarditis