Case Report :

ST Elevation
Myocardial Infarction
Presented by
Dzulfadhil Syamsir
Supervisor
Dr. Abdul Hakim Alkatiri, Sp.JP, FIHA

Department Of Cardiology And Vascular Medicine

Medical Faculty Of Hasanuddin University
Makassar
2016

Patient Identity
Name

: Mr. BT

Date of Birth / Age: 11-09-1958 / 57 y.o

ID

: 450384

Occupation

: Civil Worker

Marriage Status

: Marriage

Addres

: Pangkep

Date Of Admission: 09/02/2016

History
Chief Complaint : Breathless
Anamnesis :
Suffered since 1 weak ago, worsened one day ago. DOE
(+), Ortophneu (-), PND (-). Patient sleep with two pillows.
There are chest pain and epigastric pain but not spesific.
Cough since one week ago without sputum. There is history
of nausea but no vomiting, there is no history of fever.
Defecation and urination are good.

History
Past History :
History of chest pain about 5 years ago with result of
coronary angiography is narrowing of 3 artery of the heart
Hipertension since 5 years ago, with sistolic pressure about
160 but not regulary take medication.
History of smoking
History of diabetes mellitus, not regulary take medication.
No history of alcohol consumption
No history of heart disease in family

Physical Examination
General Condition
Moderate Illness/Well Nourished / Compos Mentis (GCS
15)
Vital Sign
Blood pressure: 150/100 mmHg
Heart rate

: 110 bpm

Respiratory rate
Temperature

: 33 rpm

: 36,5 oC

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 axillaris anterior sinistra
Auscultation : heart sound I/II pure, regular, murmur (-)

ECG

Laboratory Examination
TEST

TEST

RESULT

RESULT

NORMAL
VALUE

NORMAL
VALUE

Tot.Choles

212mg/dl

200

HDL

51 mg/dl

>59

LDL

121 mg/dl

130

12 16

Trigliserida

134 mg/dl

200

44,4

37 48

Ureum

36

10-50

188x 103/uL

150 400 x

Kreatinin

1,09

0,5-1,2

PT

11,7

103
10 - 14

Troponin I

0,13

<0,01

APTT

27,9

22,0 - 30,0

CK

204

<190

INR

1.13

CKMB

59,7

<25

GDS

347mg/dl

140

Natrium

134

136 - 145

GD2PP

<200

Kalium

4,9

3,5 - 5,1

SGOT

36 u/L

<38

Klorida

106

97 - 111

SGPT

45 u/L

<41

Asam Urat

3,4-7,0

11000 x 103/uL

WBC

4.0 10.0 x

RBC

4.71

10
4.0 6.0 x 106

HGB

14,9

HCT
PLT

X-Ray Imaging

Resume
Male, 52 y.o, admitted to the hospital with chief
complaint breatless since one week ago and worsened
one day ago. DOE (+), chest pain (+) epigastric pain
(+), cough (+) w.o sputum.
History of chest pain 5 years ago with result of coronary
angiography is narrowing of 3 artery in the heart but
patient refused PCI.
History of smoking, History of hipertension and DM
since 5 years ago but not taking medication regulary.

Resume
ECG shown sinus tachycardia, regular, HR 115 bpm,
normoaxis, anteroseptal wall myocardial infarction and
LVH
Laboratory result WBC : 11.100, GDS : 347, CK 204,
CKMB 59,7, Troponin I 0,13.
Chest X-Ray Cardiomegaly with signs of pulmonary
edema and Dilatatatio elongation et atherosclerosis
aortae

Diagnosis
STEMI onset >12 hours, KILLIP II
Hipertensi Heart Disease
DM Tipe II Non Obesed

Treatment

Oksigen 2-4 lpm via nasal kanul

IVFD NaCl 0,9% 500 cc/24 hours/IV
Aspilet 160mg 80mg/24 hours/oral
Clopidogrel 300mg 75 mg/24 hours/oral
Isosorbid 10 mg/8 hours/oral
Arixtra 2,5mg/24 hours /SC
Furosemide 40mg/12 hours/IV
Captopril 12.5mg/8 hours /oral
Atorvastatin 20 mg/24 hours/oral
Alprazolam 0,5mg/24 hours/oral
Laxadyne syr 10ml/24 hours/oral
Levemir 0-0-10 mcg/SC
Novorapid 6-6-6 mcg/SC

Discussion

Anatomy & Physiology

Definition of ACS
Acute coronary syndrome (ACS) refers to a spectrum of
clinical presentations ranging from those for ST-segment
elevation myocardial infarction (STEMI) to presentations
found in nonST-segment elevation myocardial infarction
(NSTEMI) or in unstable angina. It is almost always associated
with rupture of an atherosclerotic plaque and partial or
complete thrombosis of the infarct-related artery.

Pathopyhsiology

Pathopyhsiology

Diagnosis

Diagnosis

Treatment
EMR

First 10 Minutes
1. ECG
2. Heart Biomarker
3. O2 & IV Fluid
4. ECG Monitor
5. Medication

Assesment Of ECG
1. ST Segment Elevation
-> Trombolitik / PCI
2. Ischemia (?)-> Anti
Ischemia, CVCU
3. Normal ECG ->
Monitoring & Evaluation
After 12 hours of ECG &
biomarkers

Treatment

Treatment

Thank You