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CUTE CORON RY

SYNDROME

PROGRAM PENDIDIKAN MAGISTER

KEDOKTERAN JANTUNG DAN PEMBULUH DARAH

FAKULTAS KEDOKTERAN

UNIVERSITAS SUMATERA UTARA

PRESENTATOR : dr.MARWAN NASRI

PEMBIMBING : Prof.dr.HARRIS HASAN,SP.PD (K), SP.JP (K)


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DEFINITION

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

(STEMI) or in unsta!le angina"

It is almost al#ays associated #ith rupture of anatherosclerotic pla$ue and partial or complete

throm!osis of the infarct-related artery"


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UNIVERSAL DEFENITION

MYOCARDIAL INFARCTION


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UNIVERSAL DEFINITION OF

MYOCARDIAL INFARCTION


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5

Hospitalizations in the U.S. Due to

Acute Coronary Syndromes (ACS)

Acute CoronarySyndromes*

1.57 Million Hospital Admissions - ACS

UA/NSTM!% STM!

1."# millionAdmissions per year

.$$ millionAdmissions per year

Heart %isease and Stro&e Statistics ' "((7 Update. Circulation

"((7) 115+,-171. *rimary and secondary dianoses. A0out(.57 million NSTM! and (.+7 million UA.


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ATHEROSCLEROSISTIMELINE


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MECHANISMS OF

CORONARY THROMBOSIS

Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 7


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CONSEQUENCES OF

CORONARY THROMBOSIS

Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 7!


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INITI L

EV LU TION

ND

M N GEMEN

T


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CHEST PAIN


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ECG ASSESSMENT


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ECG ASSESSMENT

ECG manifestations of acute myocardial

ischaemia in a!sence of L"H and L###$

ECG chan%es associated &ith 'rior

myocardial infarction

AC(TE STEMI


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Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page "2

AC(TE STEMIE"OL(TION


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BIOM RKER FOR CS


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18/66Copyrit 2"((7 American Collee o3 Cardioloy 4oundation. estrictions may apply.

Anderson) *+ L+ et al+ * Am Coll Cardiol ,--./0-1e23e20.

TIMING OF RELE SE OF V RIOUS BIOM RKERS

FTER CUTE MYOC RDI L INF RCTION


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BIOM RKER FOR CS

E#ropean Heart $o#rnal %20& !2,2''' ( !0)4


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TROPONIN KINETICS IN THE INDEX C SES

6aha3an 78 +arolim #. Circulation 20,2/:290129/

*opyright + merican Heart ssociation, -nc. ll rights resered.


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/reatment of c#te/reatment of c#te

*oronary yndromes1*oronary yndromes1

/E s. on /E/E s. on /E


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&reatment o% Acute Coronary&reatment o% Acute CoronarySyndromesSyndromes

Anti1ischemic therapiesAnti1ischemic therapies

eneral measures:eneral measures:

Antithrom;otic therapiesAntithrom;otic therapiesAntiplatelet aents:Antiplatelet aents:

Anticoaulants (use one):Anticoaulants (use one):

Ad3uncti'e therapies:Ad3uncti'e therapies:

33(loc5er(loc5er itratesitrates 6( *alci#m channel loc5er6( *alci#m channel loc5er

Pain control %morphine&Pain control %morphine& #pplemental 8#pplemental 822if neededif needed

spirinspirin *lopidogrel %or pras#grel&*lopidogrel %or pras#grel& 9P -----a inhiitor %for selected high9P -----a inhiitor %for selected high

ris5 patients: may e deferred #ntil P*-&ris5 patients: may e deferred #ntil P*-&

L;WH %eno


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STEMI


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REPERFUSI


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R!"#$$!%&'()#% *#+ R!,!+*-.)#% T/!+',


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REPERFUSION THERAPY FOR STEMI


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Date of doAnload1422204

*opyright + /he merican *ollege of *ardiology.ll rights resered.

From: eper%usion Strateies in Acute S&1Sement !le'ation 6yocardial $n%arction: A Comprehensi'e e'ie

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