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SUCIATI
SITI ARIFAH
A.YUSRIANA AZZARAH
NURUL INDAH PERTIWI
BESSE JUMRANA
ARMAWATi
SRI MEGAWATI
Supervisor :
DR dr. Idar Mapangara, SpPD, SpJP, FIHA, FICA, FINASIM
Vital state
Blood Pressure : 130/80 mmHg
Heart Rate : 80 x/mnt
Respiratory Rate: 18x/mnt
Body Temperature: 36,5 C (axilla)
Physical
Head Examination
:Normochepalic
Eye :Anemis (-), Icteric (-)
Pupil :Equal, round, diameter 2,5 mm, reactive
to light
Nares :Appearance is normal
Lip :No cyanosis
Neck :JVP R+2 cmH2O, no lymphadenopathy,
no thyroid enlargement
Physical Examination
Chest Examination
Inspection : Symmetrical left = right
Palpation : Mass (-), tenderness (-),
Percussion :Sonor left=right;
Lung-liver border in ICS VI anterior
Auscultation : Breath sound : vesicular
Additional sound : ronchi -/-
wheezing -/-
PHYSICAL EXAMINATION
Cor :
Inspection : ictus cordis is visible
Palpation : ictus cordis palpable, thrill (-)
Percussion :
Upper border 2nd ICS sinistra
Right border 4th ICS linea parasternalis dextra
Left border 5th ICS linea axillaris anterior
sinistra
Auscultation : heart sound I/II pure, regular,
murmur (-)
Physical Examination
Abdominal Examination
Inspection : Convex, following breath movement
Auscultation : Peristaltic sound (+), normal
Palpation : Mass (-), tenderness (-), no palpable
liver and spleen
Percussion : Timpani (+), Ascites (-)
Extremities examination
Pretibial edema -/-
Dorsum pedis edema -/-
ELECTROCARDIOGRAPHY
Sinus rhytm
HR : 90 bpm
Regularity: regular
Axis : normoaxis
PR interval : 0.12 s
QRS rate : 0.08 s
QRS complex :
normal
ST segmen :
ST segmen
elevation on lead
II,III,aVF, on lead
V5 ,V6
Conclusion :
Sinus rhytm, HR :
90 bpm, inferior +
lateral walls
myocardial
infarction
LABORATORY RESULTS
TEST RESULT NORMAL TEST RESULT NORMAL
VALUE VALUE
LDL - 130
HGB 12.9 12 16
Triglyceride - 200
HCT 36,2 37 48
295x 103/uL Ureum 17 10-50
PLT 150 400 x 103
Creatinine 0.69 0,5-1,2
Result :
Active old
pulmonary
tuberculosis wide
lesion
Left pleural effusion
DIAGNOSIS
ST ELEVATION MYOCARDIAL
INFARCTION INFERIOR + LATERAL 5
HOURS ONSET
TREATMENT
Oxygen 2-4 liters per minute via nasal cannule
IVFD NaCl 0,9% 500 cc/24 hours/IV
Nitrate (Cedocard) 1 mg/jam/syringe pump
Aspirin 160mg (loading dose) 80mg/24
hours/oral (maintenance)
Clopidogrel 300mg (loading dose) 75 mg/24
hours/oral (maintenance)
Actilyse (Fibrinolytic) :
15 mg bolus iv
50 mg/syringe pump in 30 minutes
35 mg / syringe pump in 60 minutes
Simvastatin 40 mg/24 hours/oral
Captopril 12,5 mg/8 hours/oral
Bisoprolol 2,5 mg/24 hours/oral
DISCUSSION
Introduction
Acute coronary syndromes (ACS) is a
term for situations where the blood
supplied to the heart muscle is
suddenly blocked.
described as a group of conditions
resulting from acute myocardial
ischemia (insufficient blood flow to
heart muscle)
ranging from unstable angina
(increasing, unpredictable chest
pain) to myocardial infarction
(heart attack).
Introduction
PATHOPHYSIOLOGY