Assessing Chest pain

Character
Time of onset, duration, frequency
Changes in tempo
Exacerbating and alleviating factors
Pain during situation associated with
increased myocardial O2 demand
( e.g. exertion, stress )

SINDROM KORONER AKUT

Merujuk pd sekumpulan keluhan dan tanda klinis yang sesuai
dengan iskemia miokard akut
Mencakup Infark miokard akut ( dgn elevasi /depresi segmen ST ,
gelombang-Q dan non gel Q) dan angina tidak stabil ( UAP)

Sindrom Koroner Akut

Tanpa elevasi ST

Elevasi ST

NSTEMI

Angina Tdk Stabil

Infark Miokard Akut

NQMI
Qw MI
Kursus SKA

Immediate Assessment in
ED

If

Vital signs, including blood pressure

Oxygen saturation
IV access
12-leads ECG
Brief, targeted history and physical exam (to identify
reperfusion candidates)
Fibrinolytic check list; check contraindications
Obtain initial cardiac markers
Portable Chest X-ray < 30 min.
Assess for the following :
-Heart rate > 100 bpm and SBP < 100 mmHg
-Pulmonary edema/rales or
-Signs of shock
any of these conditions is present, consider triage to a
facility capable of cardiac catheterization and
revascularization

Early Repolarisation !!!

LOKASI ISKEMIA
BERDASARKAN PERUBAHAN DI SANDAPAN EKG
SANDAPAN
II ,III, aVF
V1,V2,V3
V1-V4
V1- V6
I,aVL ,V5,V6
I, V6
V7-V9
V4R

LOKASI ISKEMIA / INFARK

Inferior
Anteroseptal
Anterior
Anterior ekstensif
Lateral
Apikal
Posterior
Ventrikel kanan

Emergency Department
(1)
AMI Protocol
-ECG screening within 10 minutes
-Door-to-drug time < 30 minutes
-Door-to-balloon time inflation < 90 minutes
For all patients with ischemic-type chest
pain, provide supplementary oxygen, IV
access, and continuous ECG monitoring

Emergency Department
(2)
Reperfusion therapy for ST-segment
elevation MI (STEMI)
- Rule out contraindications and assess riskbenefit ratio.
-Consider PCI if ineligible for fibrinolytics
-angiography for cardiogenic shock
(angioplasty or CABG if indicated)
Prompt aspirin (160-325 mg) for all patients
with AMI who are reperfusion candidates.

Emergency Department
(3)
Beta-blockers for all patients without
contraindications.
IV nitroglycerin for initial 24-48 hrs
in patients with AMI and CHF, large
anterior infarction, persistent
ischemia, or hypertension.

Fibrinolytics
Absolute Contraindications :
-Any prior intracranial hemorrhage (ICH)
-Known structural cerebral vascular lesion (eg. AVM)
-Known malignant intracranial neoplasma
-Ischemic stroke within 3 month EXCEPT acute
ischemic stroke within 3 hrs
-Suspected aortic dissection
-Active bleeding or bleeding diasthesis
-Significant closed head trauma or facial trauma
within 3 months

Fibrinolytic
Relative Contraindications :
- Check your handbook !!!

Thank you