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Coronary Syndrome di
Layanan Pratama
Inisialisasi Dini Acute Coronary Syndrome
• Typical Angina
• Likelyhood or Probability
• EKG ,,, ECG
• Differensiasi ACS
• Stratifikasi Resiko
Typical Angina
Kecendrungan
EKG
ECG in NSTEACS1,2
▪ Normal ECG in more than 1/3 of patients
▪ Abnormalities
• ST Depression
• Transient ST Elevation
• T-Wave changes
Flattening of Horizontal
ST Segment ST Segment
References: 1. Roffi M et al. Eur Heart J 2016;37(3):267-315; 2. Channer K, Morris F. BMJ 2002;324:1023–6
Tatalaksana awal Angina Pectoris
Angina Pectoris
• O2 ( bila SpO2 < 90% )
• Nitrat ( ISDN 5 mg SL , bisa di ulang tiap 15 menit )
• Loading anti platelet
• A. Asam Asetosalisilat ( Aspilet ) 320 mg
• B. Clopidogrel 300 mg
• Segera tentukan Angina typical atau bukan? ACS atau bukan ? STEMI atau
NSTE - ACS
Acute Coronary Syndrome (ACS)1
ST
ST
depression ST segment
ECG elevation
Diagnosis
STEMI NSTEMI UA
12
• Cardiac • 43
Creatinine, Score Low risk: Score ≤ 108
(µmol/L)
arrest at • 15 In-hospital death: <1%
admission • 30 0 - 34 2
• Elevated 35 – 70 5
cardiac 71 – 105 8
106 – 140 11
13
markers
• ST Segment 141 – 176 14
deviation 177 – 353 23
≥ 354 31
Reference: 1. Khalill R et al. Exp Clin Cardiol.2009; 14(2): e25 – e30; 2. Hamm CW et al. Eur Heart J. 2011
Risk Criteria Mandating Invasive Strategy
in NSTE-ACS1
• Hemodynamic instability or cardiogenic • Relevant rise or fall in troponin
HIGH RISK
• Recurrent or ongoing chest pain (symptomatic or silent)
refractory to medical treatment • GRACE Score > 140
• Life-threatening arrhythmias or cardiac
arrest
• Mechanical complications of MI
• Acute heart failure
• Recurrent dynamic ST-T wave changes,
particularly with intermittent ST-
elevation
INTERMEDIATE
LOW RISK
(eGFR <60 mL/min/1.73 m²)
• LVEF < 40% or congestive HF
• Early post infarction angina
• Prior PCI
• Prior CABG
• GRACE risk score 109 - 140