NON-ST ELEVATION

MYOCARDIAL INFARCTION
ANDI NUZUL JUMHARI
C111 13 501

SUPERVISOR :
dr. Akhtar Fajar M, Sp.JP, FIHA

DEPARTMENT OF CARDIOLOGY AND VASCULAR MEDICINE

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
MAKASSAR
2018
1
Agenda

1 CASE REPORT

DISCUSSION
2 NON-ST ELEVATION MYOCARDIAL INFARCTION
2

Case report
Non-st elevation myocardial infarction
3
PATIENT IDENTITY
Name : NY. SU
Age : 62 years old
Address : Mamuju
MR : 257220
Date of Admision : February 24th 2018
4 HISTORY TAKING
Case report – Ny. SU, NSTEMI

Chief complaint : C
A Chest pain

Present Illness History :

B Chest pain is felt 7 hours before admitted to the hospital. Chest pain as pressured on her
left chest with duration more than 20 minutes.
At that time the patient was awakened at 01.00 am due to chest pain caused,Chest pain
radiated to the left arm and shoulder.
the patient consumed nitrate once but the chest pain did not subsided
Cold sweat (+) , Dyspnea on effort (-), Ortopneu (-), Paroxysmal noctural dypsneu (-),
cough (-), Nausea (+) vomiting (-), epigastric pain (+).
Defecation and urination is normal.
5 HISTORY TAKING
Case report – Ny. SU, NSTEMI

Past Illness History :

 History of Hypertention (+) from 2007,
take medicine regularly.
 Dislipidemia (+),
 History of previous chest pain (+), from 2007
 History of diabetes melitus (-)
 Family history of heart disease (+)
 Family history of hypertention (+)
 Family history of dislipidemia (+)
6 HISTORY TAKING
Case report – Ny. SU, NSTEMI

Personal History :
 History of alcohol consumption (-)
 History of smoking (-)
7 HISTORY TAKING
Case report – Ny. SU, NSTEMI

Personal History :
General Appearance :
Moderate illness / overweight/ Composmentis

Vital Sign :
• Blood Pressure : 123/75 mmHg
• Pulse : 107 bpm, regular
• Respiratory rate : 20 tpm
• Body temperature : 36,0º C

Head Examination :
• Eyes : anemia(-), icterus(-),
• Lip: cyanosis(-)
• Neck : JVP R+2 cmH20
8 HISTORY TAKING
Case report – Ny. SU, NSTEMI

Personal History :
General Appearance :
Moderate illness / overweight/ Composmentis

Vital Sign :
• Blood Pressure : 123/75 mmHg
• Pulse : 107 bpm, regular
• Respiratory rate : 20 tpm
• Body temperature : 36,0º C

Head Examination :
• Eyes : anemia(-), icterus(-),
• Lip: cyanosis(-)
• Neck : JVP R+2 cmH20
9 HISTORY TAKING
Case report – Ny. SU, NSTEMI
Thoracic Examination :
• Inspection : Symmetric left and right
• Palpation : No mass, no tenderness
• Percussion : Sonor
• Auscultation : Breath Sound : vesicular, Rh -/-, wh -/-

Cardiac Examination :
• Inspection : Ictus Cordis wasn’t visible
• Palpation : Ictus Cordis wasn’t palpable
• Percussion : normal heart size
•Upper border : left ICS II
•Lower border : left ICS V
•Right border : right parasternalis line
•Left border : left medioclavicular line
• Auscultation : Regular of I/II Heart Sound, no murmur
10 HISTORY TAKING
Case report – Ny. SU, NSTEMI

 Abdominal Examination :
• Inspection : flat and following breath movement
• Palpation : liver and spleen unpalpable
• Percussion : Tympani
• Auscultation : peristaltic sound (+) , normal

 Extremities :
• Oedema pretibial -/-
11 LABORATORY FINDINGS
12 HISTORY TAKING
Case report – Ny. SU, NSTEMI
13 ELECTROCARDIOGRAPHY

24/2/2018
Rythm : sinus rhythm
HR : 107 bpm
Regularity : Reguler
Axis : Normoaxis
P wave : normal, 0.04 s
PR interval : normal, 0.16s
QRS Kompleks : 0.08 s, Pathologic Q - lead III
ST segment : depresion I, aVL, and V3-V6
elevation III, aVF
T wave : 0.04 S
Conclusion : sinus rythm, HR 107bpm regular, normoaxis, Non-ST elevation myocardial Infarcti
on, Old Myocardial infarction
14 ELECTROCARDIOGRAPHY

25/2/2018
Rythm : sinus rhythm QRS Kompleks : 0.08 s, Pathologic Q - lead III
HR : 71 bpm ST segment : depresion I, aVL, and V3-V5
elevation III, aVF
Regularity : Reguler T wave : T inverted V1-V2
Axis : Normoaxis
P wave : normal, 0.06 s
PR interval : normal, 0.12 s
Conclusion : sinus rythm, HR 71 bpm regular, normoaxis, Non-ST elevation myocardial Infarcti
on, Old Myocardial infarction
15 Diagnosis
Case report – Ny. SU

Non-ST elevation Myocard Infark

Hipertensive Heart Disease
16 TREATMENT
Case report – Ny. SU, NSTEMI

• Bed Rest
• IVFD NaCl 0.9% 500 cc/24h/IV
• Aspilet 80 mg/24h/oral
• Clopidogrel 75 mg/24h/oral
• Atorvastatin 40mg/24h/oral
• Farsorbid 10mg /8h/oral
• Ramipril 2.5 mg/24h/oral
• Arixtra 2.5mg/24h/subkutan
• Bisoprolol 5mg/24h/oral
17

DISCUSSION
Non-st elevation myocardial infarction
18 DISCUSSION
NON-ST ELEVATION MYCORD INFARCT

• Acute coronary syndromes (ACS) comprise a spectrum of clinical conditions,

initiated by rupture of an atherosclerotic coronary plaque
with overlying acute thrombosis.
• The consequences of thrombosis include direct obstruction of blood flow to the
coronary beds, as well as distal embolization of the platelet-rich thrombus. Both
of these processes may lead to myocardial ischemia and may progress to myoc
yte necrosis and myocardial infarction.
• Myocardial infaction caused by a critical imbalance between the oxygen supply
and demand of the myocardium.
19 DISCUSSION
20 DISCUSSION
ECG

ST DEPRESSION T INVERTED
21 PATHOFISIOLOGY
 Chest pain/chest dis
22 comfort may also
discribed as a dull Not fully
pain, ‘pressure’, relieved by rest or
squeezing’, or nitroglycerine
‘crushing sensation’
or burning sensation
Serum cardiac marker

Ischemic symptoms ; Clinical elevations : CK-MB,

TROPONIN T
Dyspnea
Diaphoresis Findings
Nausea and vomitting

Substernal chest
pain/chest discom Duration of chest
fort radiated to the pain 20 minutes
left arm, shoulder,
neck, jaw
23 RISK FACTOR
Discussion

Modifiable Non-Modifiable

• Smoking • Gender & Age

• Hypertension
• Diabetes mellitus
• Hypercholesterolemia
• Obesity
• Psychosocial stress
• Lack of physical activity
• Men > 45 years old
• Women > 55 years old
• Family history
• Heart disease in
biological brother or
father > 55 years old
• Heart disease in
biological sister or
mother > 65 years old
24
DIAGNOSIS
Discussion
25 TREATMENT Plaque
Discussion
stabilization
and secondary
prevention
Management
Improved of ischemia Treatment of hypertension
coronary and dyslipidemia . Tight
Prevention of glycemic control in diabetic
perfusion Pharmacologic: patients Smoking cessation,
recurrent beta-blockers, nitrates, weight reduction, regular
thrombosis Coronary morphine, calcium exercise Therapy for
revascularization: balloon channel antagonists depression and anxiety
Antiplatelet therapy: angioplasty, stenting, and
aspirin, clopidogrel, adjunctive procedures,
glycoprotein IIb/Iia coronary artery bypass
inhibitors grafting
Antithrombin therapy:
unfractionated or low
molecular weight
heparins, direct thrombin
inhibitors
26 TREATMENT
Thank you