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MYOCARDIAL INFARCTION
(NSTEMI)
FELIX HARTANTO
030.10.104
9.0%
13.0
%
2.0%
Cancer
13.0
%
Stroke
30.0%
43.0%
CHD
CVD
(16.7 M)
9.0%
33.0%
14.4%
30.0%
Other
CVD
All Other
ACUTE CORONARY
SYNDROME
Acute Coronary Syndrome (ACS) adalah
jantungdisebut infarkmiokard
Termasuk didalamACS adalah unstable
angina pektoris/infark miokard non
elevasi segmen ST (NonSTEMI), dan
infarkmiokard elevasi segmen
NSTEMI
The death of the heart muscle that is
characterized by acute symptoms of typical
angina with ECG abnormalities (without ST
segment elevation) and an increase in
cardiac enzymes.
Signs of myocardial
ischemia
ECG
ST segment
elevation?
No
Yes
STEMI
(ST-Elevation
Lab
Biochemical
cardiac markers ?
Myocardial Infarction)
Yes
NSTEMI
( Non ST-Elevation
Myocardial Infarction )
No
Unstable Angina
Risk Factors
Pathophysiology
Retrosternal pressure or
heaviness (angina) Radiating
to the left arm, neck, or jaw,
which may be intermittent
(usually lasting for several
minutes) or persistent.
These complaints may be
accompanied by other
symptoms such as diaphoresis,
nausea, abdominal pain,
dyspnoea, and syncope
uncommon
These include epigastric pain,
Management of
NSTEMI/UAP
Management strategy
Step 1. initial evaluation
Role of
primar
y care
physici
an
Management
Oxygen
Anti-ischemia drugs
nitrates
morphin / pethidin
beta blocker
ACE inhibitor
Antiplatelet drugs
aspirin
clopidogrel
GP IIb/IIIa inhibitor
Anticoagulation drugs
unfractionated heparin
low molecular weight heparin (LMWH)
Adjuvant therapy
Initial Treatment
Score
Age, years
Predictor
Score
Predictor
Score
Killip class
< 40
< 80
63
40 - 49
18
80 89
58
II
21
50 - 59
36
100 - 119
47
III
43
60 - 69
55
120 - 139
37
IV
64
70 - 79
73
140 - 159
26
80
91
160 - 199
11
> 200
Predictor
Score
Predictor
Score
Creatinine (mol/L)
< 70
0 - 34
70-89
35 70
90-109
13
71 105
110 - 149
23
106 140
11
150 - 199
36
141 176
14
> 200
46
177 353
23
354
31
Predictor
Score
Cardiac
arrest at
admission
43
Elevated
cardiac
markers
15
ST
Segment
deviation
30
Invasive strategy
An invasive strategy (within 72 h after first
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