![Page 1: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/1.jpg)
CASO CLÍNICOCASO CLÍNICO
IAM sem supra do segmento STIAM sem supra do segmento ST
Dr. Antonio Carlos Mansur BedetiSanta Casa de Belo HorizonteHospital Belo HorizonteHospital Vera CruzHospital Unimed
![Page 2: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/2.jpg)
IAM sem supra do segmento STIAM sem supra do segmento ST
Introdução
É mais prevalente que o IAMCST.
A mortalidade é semelhante a do IAMCST em 6 meses.
A ruptura de placas vulneráveis é o
principal mecanismo fisiopatológico.
Finn AV, Nakano M, Narula J, Kolodgie FD, Virmani R. Concept of vulnerable/unstable plaque. Arterioscler Thromb Vasc Biol
2010;30:1282-92.Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115:69–171
![Page 3: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/3.jpg)
Caso Clínico
Paciente 38 anos, sexo masculino, tabagista
(30anos/maço) hipertenso, sedentário,
ex-usuário de drogas ilícitas. Em uso irregular
de Enalapril 10mg (MID). Passado de vários
acidentes de trânsito (motoboy).
![Page 4: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/4.jpg)
Caso Clínico
Previamente assintomático, relata que há 15 dias
iniciou com quadro de dor precordial,
inicialmente aos esforços e stress, quando
apresentou episódio súbito de forte intensidade
em repouso associado a dispneia, vômito e
sudorese com duração de ± 20 min.
![Page 5: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/5.jpg)
Caso Clínico
• 1º Atendimento em UPA .
-Recebeu isordil, morfina, AAS, clopidogrel, propranolol e
heparina não fracionada com melhora do sintomas.
• Transferido para SCBH com 12 h de evolução com
recorrência dos sintomas anginosos .
- ECG: Inversão de onda T de V1- V4
![Page 6: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/6.jpg)
![Page 7: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/7.jpg)
Caso Clínico
Enzimas :
•CK T¹ e MB² ( V.R: 26 a 155U/L¹ e V.R: inferior 24U/L² )– 2h:141/13 8h: 328/48 12h*: 486/71(U/L)
•Troponina I ( V.R inferior a 0,11mcg/L)
– 12h*:12,3mcg/L
![Page 8: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/8.jpg)
Antman EM, et al. JAMA 2000;284:835–42
x
x
![Page 9: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/9.jpg)
HD: IAMSST
“ Baixo Risco” ?
![Page 10: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/10.jpg)
Estratégia
Invasiva vs.
Conservadora
![Page 11: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/11.jpg)
Estratégia
Jneid et al. J Am Coll Cardiol. 2012;60(7):645-681
![Page 12: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/12.jpg)
Bavry AA, et al. J Am Coll Cardiol 2006;48:1319–1325
Invasiva vs. ConservadoraRelative Risk of All-Cause Mortality
(Mean Follow-Up of 2 y)
![Page 13: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/13.jpg)
Bavry AA, et al. J Am Coll Cardiol 2006;48:1319–1325
Invasiva vs. ConservadoraRelative Risk of Recurrent MI
(Mean Follow-Up of 2 y)
![Page 14: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/14.jpg)
Bavry AA, et al. J Am Coll Cardiol 2006;48:1319–1325
Invasiva vs. ConservadoraRelative Risk of Recurrent UA
(Mean Follow-Up of 13 months)
![Page 15: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/15.jpg)
Caso Clínico
![Page 16: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/16.jpg)
Caso Clínico
![Page 17: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/17.jpg)
Caso Clínico
![Page 18: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/18.jpg)
Caso Clínico
![Page 19: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/19.jpg)
Caso Clínico
![Page 20: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/20.jpg)
Caso Clínico
![Page 21: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/21.jpg)
Caso Clínico
![Page 22: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/22.jpg)
Caso Clínico
?
![Page 23: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/23.jpg)
Caso Clínico
![Page 24: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/24.jpg)
Convencional vs. Farmacológico
![Page 25: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/25.jpg)
Network Meta-analysis:Network Meta-analysis: 38 trials, 38 trials, 18,023 pts18,023 pts
Stettler C et al. Lancet 2007;370:937- 48Stettler C et al. Lancet 2007;370:937- 48
TLR FrequencyTLR Frequency
![Page 26: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/26.jpg)
?DUPLA TERAPIA ANTI-PLAQUETARIA PROLONGADA ??
![Page 27: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/27.jpg)
Caso Clínico
![Page 28: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/28.jpg)
Caso Clínico
![Page 29: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/29.jpg)
Caso Clínico
![Page 30: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/30.jpg)
Caso Clínico
![Page 31: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/31.jpg)
Caso Clínico
![Page 32: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/32.jpg)
Caso Clínico
![Page 33: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/33.jpg)
Caso Clínico
![Page 34: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/34.jpg)
Caso ClínicoEvolução:
•Alta hospitalar em 72h.
•AAS, clopidogrel, atenolol, enalapril e sinvastatina.
•Mudança do estilo de vida.
Seguimento de 1 ano:
•Assintomático . Avaliação funcional negativa.
•Adesão ao tratamento clínico.
•Sem acidentes de trânsito.
![Page 35: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/35.jpg)
Obrigado.
![Page 36: CASO CLÍNICO IAM sem supra do segmento ST Dr. Antonio Carlos Mansur Bedeti Santa Casa de Belo Horizonte Hospital Belo Horizonte Hospital Vera Cruz Hospital](https://reader033.vdocuments.site/reader033/viewer/2022061511/552fc13c497959413d8dc0f5/html5/thumbnails/36.jpg)
Obrigado