ACUTE CORONARY SYNDROME

ST ELEVATION MIOCARD INFARCTION

ANTEROSEPTAL INFERIOR
a Case Report
by

Andri Hendratno

Preceptor:
Letkol (CKM) dr. Prihati Pujowaskito, Sp. JP (K), MMRS

Cardiology Department
Dustira Educational Hospital Cimahi
2017

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 Patient’s Identity
• Name : Mrs. R
• Gender : Female
• Age : 67 Years old
• Address : Yuda Wastu Pramuka 15 RT
06/13
• Occupation : Housewife
• Religion : Islam
• Tribe : Sundanese
• Admission date : September 24 th 2017

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 Chief Complaint

Chest pain
History of Present illness
• Patient attended to Emergency department complaining of
chest pain since 4 days ago and getting heavy since 6 hour
before she goes to the hospital.
• Chest pain describes as feeling as if someone were standing on
her chest or squeezing her chest.
• Chest pain was radiating to the back. It was persistent about 20
minutes.
• Chest pain also followed by shortness of breath, diaphoresis,
pain in the epigastrium, nausea, and once vomitus

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 Past Illness History

• History of Hypertension, Cholesterol, diabetes melitus,

heart disease.
• No history of stroke & chronic cough.

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 Family History

• History of hypertension in family (-)

• History of diabetes melitus (-)
• History of heart disease in family (-)

Personal and social history

• Patient not a smoker.
• Alcohol (-)
• Daily diet is high fat, enough carbohydrat and protein

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 Physical Examination

General Looked Moderate

Appearance:

Weight : 49kg
Nutritional Height : 153 cm
status:
BMI : 20,9 kg / m2
Conclusion : Normal

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 Physical Examination
BP = 140/90 HR = 70 bpm, reguler RR = 22 tpm T ax 36,5 ˚C SaO2 = 98%
mmHg

GCS : 15 Eye (4), Verbal (5), Movement (6)

Head Normal
Neck Normal

Cor SI/SII reguler, mur mur (-), gallop (-)

Pulmo Auscultation : breath sound v v Rh - - Wh - -

v v -- - -
v v -- - -

Abdomen Tenderness a/r epigastic (+)

Extremities normal

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 Laboratory Findings
(03/08/2017)
Hb : 11,0 g/dl MCV : 80,2 f
Erythrocytes : 3,7 x 106 /uL MCH : 29,8 pg
Leukocytes : 7.800 /uL MCHC : 37,2 g/dl
Ht : 29,6 % RDW : 12,6%
Platelets : 174.000/ uL Ba/Eo/Sg/Li/M:
0,5/0,5/71,1/21,2/6,7
Fasting Blood Glucose: 201 mg/dl
CKMB: 26 U/L

Ureum : 101 mg/dl Triglycerides : 120 mg/dl

Creatinin : 2,9 mg/dl LDL Cholesterol : 155 mg/dl

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 Electrocardiography (24/09/2017)

• Rhythm: sinus rhythm •P Wave : 0,08 s

• •PR Interval : 0,2 s
Frequency: 84 bpm reguler
•QRS complex : 0,06 s
• Frontal axis : normoaxis •Abnormality:
• Horizontal axis : normoaxis ST elevation in V1, V2, V3, V4, II, III, aVF
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Conclusion : STEMI Anteroseptal Inferior
Pre Cutaneus Intervention
(28/09/2017)

 LMCA : Normal
 LAD : Stenosis 70-80% in Proximal, Stenosis 70-80% in Mid
 LCx : Normal, developing to the right
 RCA : Rudimenter
 The PCI, Forced to Stop because The Contrast Was Maximum.
 Conclusion is CAD Single Vessel with Anomali Coronary
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 Diagnosis

• Clinical Diagnosis : Acute Coronary Syndrom STEMI

• Anatomical Diagnosis : Stenosis 70-80% di Proximal &
Stenosis 70-80% di Mid a/r Left Anterior Descending Artery
(LAD) serta Rudimenter a/r Right Coronary Artery
• Etiological Diagnosis : Atherosclerosis

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 Management

In Emergency Departement:
Bed Rest
Fasting
O2 via nasal canule 4 lpm (If SpO2 < 90%)
IVFD RL 500 cc/ 24 hours
 PO Loading CPG 300 mg (4 tab)
 PO ISDN 5 mg/12 jam SL
 PO Aspilet 160 mg
 PO Metformin 3 x 500 mg
 Inj. Lovenox 2 x 0,6 cc
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 Reperfusion
Management
 IVFD RL 500 cc / 24 hours
 Inj. Lovenox 0,6 cc/12 hours
 PO Aspilet 80 mg/24 hours
 PO Ticagrelor 90 mg/24 hours
 PO Atorvastatin 20 mg/24 hours
 PO Bisoprolol 2,5 mg/24 hours
 PO Valsartan 80 mg/24 hours
 PO ISDN 5mg SL
 PCI education  family accept
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 Prognosis
 Quo ad vitam : dubia ad malam
 Quo ad functionam : dubia ad malam
 Quo ad Sanactionam: dubia ad malam

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 Thanks

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