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NSTEMI (NON ST

ELEVATION MYOCARDIAL
INFARCTION)
By :
Ashari Mohpul C 111 08 31
Supervisor :
Dr. dr. Idar Mappangara, Sp.PD., Sp.JP., FIHA.
Car!iolo"# D$par%&$'%
M$!i(al Fa(ul%# o) *asa'u!!i' +'i,$rsi%#
-01.
PATIENTS IDENTITY

Name : Mrs. KR

Gender : Female

Age : 45 years old

RM : 624!"

#a$e o% Admission :Augus$


"2
nd
& 2'"4
History Taking
()ie% (omplain$:
Ch$s% pai'
Guided Anamnesis:

Symptoms !"t sin#! $ %o&rs '!or! admitt!d to %ospita".


Symptoms (as trigg!r!d 'y a#ti)ity, it (as !"t "ik! %!a)y
pr!ss!d at !pigastri# ar!a and it radiat!d to t%! "!t arm.
T%! d&ration (as *+, min. it (asnt r!"i!)!d 'y
#ons&ming ISDN -mg.S/ and r!st. It &s&a""y
a##ompani!d 'y #o"d s(!ating. History o #%!st pain
'!or! 012 a'o&t 3 y!ar ago and in %ospita"i4!d. History in
angiograp%y and ad)is!d to #oronary st!nt. 5!g&"ar
m!di#a" tr!atm!nt %istory 012.

So6 072, %istory o So6 '!or!072, DoE 072, PND 072,


ort%opn!a 072

History o HT 072, DM 072

8igar!tt! Smooking 072

9rination and d!!#ation r!mains norma"


Past I""n!ss History

*is%or# o) h#p$r%$'sio' (/)

*is%or# o) !#slipi!$&ia (0)

*is%or# o) DM is !$'i$!

*is%or# o) s&o1i'" (0)

Fa&il# his%or# o) (ar!io,as(ular


!is$as$ (0)

*is%or# o) (h$s% pai' (/)2 1 #$ar a"o2


r$li$,$! 3i%h r$s% a'! (o'su&i'" ISDN
4&"5SL 6
5isk Fa#tors
Ris* Fa+$ors :

F$&al$ .4 #$ars ol!

*is%or# o) (h$s% pai' 1 #$ar a"o

*is%or# o) h#p$r%$'sio'
8"ini#a" E:amination
G,N,RA- S.A.,
Mo!$ra%$ ill'$ss5(!""7
no&ris%!d5(o's(ious
/0.A- S0GN
7
7loo! pr$ssur$ 8 130580 &&*"
7
9uls$ 8 110 %i&$s5&i'
7
7r$a%hi'" 8 18 %i&$s5&i'
7
T$&p$ra%ur$8 3:24
0
C (A;illa)
1ead ,2amina$ion

E#$s 8 a'$&i( 0502 i(%$rus 0502 o$!$&a


palp$<ra 050

Lip 8 (#a'osis (0)


N$(18 =V9 R/- (&*
-
O (30
,
)
()es$ ,2amina$ion

I'sp$(%io' 8 s#&&$%ri( R>L2


'or&o(h$s%

9alpa%io' 8 &ass (0)2 %$'!$r'$ss (0)2


,o(al )r$&i%us ri"h% > l$)%

9$r(ussio' 8 so'or l$)% a'! ri"h%

Aus(ul%a%io' 8 <r$a%h sou'! 8


,$si(ular

a!!i%io'al sou'! 8 ro'(hi
050
3h$$?i'" 050
(ardia+ ,2amina$ion

I'sp$(%io' 8 IC is 'o% ,isi<l$

9alpa%io' 8 IC is 'o% palpa<l$

9$r(ussio' 8 Ri"h% h$ar% <or!$r i' l$)%


paras%$r'al li'$2 l$)% h$ar%
<or!$r i' l$)% &i!(la,i(ular li'$

Aus(ul%a%io' 8 R$"ular I5II h$ar% sou'!2


&ur&ur (0)
A3dominal ,2amina$ion

I'sp$(%io' 8 Fla% a'! )ollo3s


<r$a%h &o,$&$'%

Aus(ul%a%io' 8 9$ris%al%i( sou'! (/)

9alpa%io' 8 Li,$r a'! spl$$' 'o%


palpa<l$

9$r(ussio' 8 Ti&pa'# (/)


,2$remi$ies
-
O$!$&a 8 9r$%i<ial 050
Dorsu& p$!is 050
E/E8T5;8A5DI;<5AM
Sin&s r%yt%m , H5 =- :.min&t!, "!t a:is d!)iation, P (a)! ,,,>s, P5 int!r)a" ,,3+ s, ?5S #omp"!: ,,,> s,
Conclusion: Sinus rhythm,
INTE5P5ETATI;N

R)y$)m : sinus r)y$m

4RS ra$e : 1R 5 3pm

5 6ave : '.'7 se+

5R in$erval : '."6 se+

4RS +omple2 : '.'7 se+

A2is : Normoa2is

S. segmen$ : S. depression a$
/!& /6

(on+lusion: Sinus r)y$)m& in%erior


and an$ero sep$al 8M0& an$ero
la$eral 6all myo+ard is+)emi+
LABORATORY FINDINGS
TEST RES+LT NORMAL VAL+E
@7C
=,= : 3,
$
.&/ .2001020 ; 10
3
5l
R7C
@,> : 3,
A
.9" .200:20 ; 10
:
5l
*A7
3@,3mg.d"
132001B20 "5!l
*CT
@,,3 B
.02004.20 C
ADS 104 &"5!l 1.0 &"5!l
+r$u&
$3 mg.d"
10040 &"5!l
Cr$a%i'i'
,,- mg.d"
M(D123)EF(D121)
&"5!l
9LT
$+3 : 3,
$
.&/ 1400400 ; 10
3
5l
TEST RES+LT NORMAL VAL+E
CF C, 9./ L(D10) 9 (D1:B)
Tropo'i' T D,,+ N$"a%i)
SAOT $+ mg.d" D38 +5l
SA9T -$ mg.d" D.1 +5l
To%al Chol$s%$rol $@+ mg.d" -00 &"5!l
*DL -3 mg.d" M(G44)EF(G:4)
&"5!l
LDL 3-= mg.d" D130 &"5!l
TA +A= mg.d" -00 &"5!l
+ri( A(i! .63 &"5!l -2.042B &"5!l
8%!st E75ay
Conclusion:

8ardiom!ga"y, 8TI ,,--

Di"atatio !t !"ongatio
aorta!
CHEST !RAY "A
F;5GIN< DIA<N;SIS

#nst$%l& An'in$ "&ctoris


T5EATMENT

;
+
+7@ /PM )ia Nasa" 8an&"!

IHFD Na8" ,,CB 3+ dpm

Nitrat! I ISDN Fasor'id 03,mg.##2 +mg.%o&r.SP

Anti7p"at!"!t aggr!gation I
Aspi"!t >, mg ,737,
8"opidogr!" 0P"a)i:2 =- mg 37,7,

Anti7#oag&"ant I Ari:tra +,-mg.+@%rs.S8

Statin I Sim)astatin +,mg 0,7,732

H+ antagonis I 5anitidin 3amp.>Jam.IH

Anti7an:i!ty I A"pra4o"am ,.- mg 0,7,732 p.r.n

/a:ati)!I /a:adyn! syr ,7,7+8


DIS89SSI;N
Coro'ar# Ar%$r# Dis$as$
Sta'"! Angina P!#toris
DEFINITION
An'in$ (&ctoris is a syndrom!
#%ara#t!ri4!d 'y #%!st pain r!s&"ting rom an
im'a"an#! '!t(!!n ;
+
s&pp"y K d!mand, and
is most #ommon"y #a&s!d 'y t%! ina'i"ity o
at%!ros#"!roti# #oronary art!ri!s to p!r&s!
t%! %!art &nd!r #onditions o in#r!as!d
myo#ardia" ;
+
#ons&mption6
CLASSIFICATION
6as!d on 8ANADIAN 8A5DI;HAS89/A5 S;8IETY
F9N8TI;NA/ 8/ASSIFI8ATI;N

8/ASS I No angina (it% ordinary a#ti)ity. Angina (it%


str!n&o&s, rapid or pro"ong!d !:!rtion.

8/ASS II S"ig%t "imitation o ordinary a#ti)ity L angina (%!n


(a"king &p stairs 'risk"y, or (a"king on a #o"d or (indy day.

8/ASS III Mark!d "imitation L angina (%!n (a"king at


norma" pa#! &p "ig%t o stairs, or (a"king 37+ '"o#ks
distan#!.

8/ASS IH Angina on minima" !:!rtion or at r!st.


PATH;<ENESIS

P"aM&! r&pt&r!

T%rom'&s ormation

In#omp"!t!. int!rmitt!nt
o##"&sion o t%! ina#t7
r!"at!d )!ss!" to t%!
pr!s!n#! o #o""at!ra"
#%ann!"s. to sma"" si4!
o a!#t!d )!ss!"
8ardio"ogy, D!smond <. J&"ian, J.8amp'!"" 8o(an, Jam!s M.
M#/!na#%an, >
t%
!dition, E"s!)i!r, +,,-
Causes of Unstable Angina

Reduction in oxygen supply to myocardium

Coronary artery narrowing from non-occlusive thrombus on a


disrupted atherosclerotic plaque

Dynamic obstruction by coronary vasospasm or vasoconstriction

Severe narrowing without thrombus or spasm

progressive atherosclerosis

Restenosis after Percutaneous coronary intervention

Arterial inflammation and infection

!ncreased myocardial oxygen demand in the presence of


fixed restricted oxygen supply

"ever# tachycardia# thyrotoxicosis# anemia


5ISG FA8T;5
5ISG FA8T;5
Mo!iHa<l$ 8
0 S&o1i'"
0 *#p$r%$'sio'
-
D#slipi!$&ia
-
Dia<$%$s &$lli%us
-
O<$si%#
Mo!iHa<l$ 8
0 S&o1i'"
0 *#p$r%$'sio'
-
D#slipi!$&ia
-
Dia<$%$s &$lli%us
-
O<$si%#
No'0Mo!iHa<l$ 8
0 Fa&il# *is%or# o) CVD
0 A"$
0 A$'!$r
No'0Mo!iHa<l$ 8
0 Fa&il# *is%or# o) CVD
0 A"$
0 A$'!$r
DIAANOSIS
Forking Diagnos!
Isch&mic sym(toms

Pro"ong!d pain 0&s&a""y *+, mins2 N #onstri#ting,


#r&s%ing, sM&!!4ing

9s&a""y r!trost!rna" "o#ation, radiating to "!t #%!st, "!t


arm, #an '! !pigastri#

Dyspn!a

Diap%or!sis

Pa"pitations

Na&s!a.)omiting

Mi"d %!ada#%!
8"ini#a" Mani!station
DIA<N;SIS

8"ini#a" %istoryI
-
In#r!as! r!M&!n#y and s!)!rity o t%!
pain
-
Pr!7!:isting angina
-
/ast "ong!r t%an 3, min&t!s to s!)!ra"
%o&rs
-
Not r!"at!d to a#ti)iti!s
-
Pain may '! int!rmitt!n
-
Not r!"i!)! 'y nitrat!
8ardio"ogy, D!smond <. J&"ian, J.8amp'!"" 8o(an, Jam!s M.
M#/!na#%an, >
t%
!dition, E"s!)i!r, +,,-
29
9ns$a3le Angina
.)erapeu$i+ Goals
$reatment for unstable angina focuses on three
goals%

S%a<ili?i'" any plaques that may have


ruptured in order to prevent a heart attac&#

R$li$,i'" symptoms

Tr$a%i'" the underlying coronary artery


disease 'CAD()
MANA<EMENT
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