Acute coronary

syndrome

Intan Rahmania Eka Dini

Epidemiology

tiap tahun > 1,2 juta penduduk amerika

terkena ACS
220.000 berakhir dengan kematian atau MI
Approximately 70% of these will have NSTEACS
5,4% kunjungan ke ruang emergency
dikarenakan sakit dada yang diindikasikan
ACS.

Coronary Artery Plaque

Pathophysiology

Complication

Cardiogenic Shock with MI

Heart Failure
Valvular dysfunction
Ventricular and arterial tachyarithmia
bradicardia
Heart Block
Periocarditis
Stroke Secondary to LV trombus embolism
Ventricular fibrilation

SYMPTOMS

gejala klasik
ketidaknyamanan dada.
Gejala yang menyertai termasuk lengan,
punggung atau
nyeri rahang,
mual, muntah,
atau sesak napas.

SIGN, LAB AND DIAGNOSTIC

TEST

Takikardi, bradikardi, heart block

EKG
Biochemical Marker Troponin I dan Troponin
T
CK- MB
Lipid Profile
CBC and Coagulation Test
Potasium dan Magnesium
Low EF <40%

Goal Target

Mengembalikan aliran darah dan mencegah

oklusi lebih lanjut
Mencegah komplikasi ke MI dan kematian
Mencegah oklusi berulang dan infark
berulang
Mengobati Ketidaknyamanan gejala
mengembalikan perubahan gelombang EKG
menjadi normal

Non Pharmacology

PCI (Percutaneous Coronary Intervention)

CABG

PCI

Cardiogenic Shock
KI fibrinolytic
symptom onset > 3 hour
Failed of fibrinolisis

Pharmacology
Treatment

E-BOOK\__Pharmacotherapy__8th_Edition__20
11_.chm
C:\Users\intan\Downloads\Circulation-2013--e
362-425.pdf

Nitroglyserine

dilatasi pembuluh darah (arteri koroner),

mereduksi tekanan diastolik pada ventrikel
kiri meningkatkan suplai oksigen
dilatasi pembuluh darah perifer, mengurangi
tekanan darah tubuh mengurangi
kebutuhan oksigen miokardial

Fibrinolytic therapy

should considered for patient 12-24 hours

benefit <12 hours

Thienopyridine

Ticlopidine, Clopidogrel, Prasugrel

Block platelet aggregation
Ticlopidine neutropenia CBC (3 month
use)
Clopidogrel and Prasugrel Prodrug
Prasugrel 3 rd Generation Less Dependent
CYP2C19
ASA Block Platelet activation

Anticoagulant

Block in Trombin generation

Fondaparinux
LMWH
Heparin (UFH)
Bivalirudin
Enoxaparine
aPTT monitoring
Enoxaparine dose adjusted for Renal function
not been Approved FDA for dialisis patient

Beta Bloker

mengurangi kebutuhan oksigen

heart rate, miokard contractility, Blood
pressure
Side Effect Bradikardia, Hypotention, Heart
Block.

CCB

for patient who have contraindicated BB

Vasodilator
First generation-> dihidropyridine
-dipine more potent negatif inotropic
Second generation verapamil, diltiazem

ACE Inhibitor and

ARB

prevent cardiac remodeling

improvement endotelial function
reduction arterial and ventricular arithmias
promotion angiogenesis
Angioedema anticipated for patient with a
prior of angioedema

Other medication

Lipid lowering agent

Morphine
oxygen therapy