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    This case report summarizes a 62-year-old female patient presenting with chest pain. She has a history of hypertension and dyslipidemia. Initial ECG shows ST depression and elevated cardiac markers consistent with a non-ST elevation myocardial infarction. She is diagnosed with NSTEMI and treated medically with aspirin, clopidogrel, statin, beta-blocker, and ACE inhibitor. The discussion covers the pathophysiology, risk factors, diagnosis, and treatment of NSTEMI.

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    This case report summarizes a 62-year-old female patient presenting with chest pain. She has a history of hypertension and dyslipidemia. Initial ECG shows ST depression and elevated cardiac markers consistent with a non-ST elevation myocardial infarction. She is diagnosed with NSTEMI and treated medically with aspirin, clopidogrel, statin, beta-blocker, and ACE inhibitor. The discussion covers the pathophysiology, risk factors, diagnosis, and treatment of NSTEMI.

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    This case report summarizes a 62-year-old female patient presenting with chest pain. She has a history of hypertension and dyslipidemia. Initial ECG shows ST depression and elevated cardiac markers consistent with a non-ST elevation myocardial infarction. She is diagnosed with NSTEMI and treated medically with aspirin, clopidogrel, statin, beta-blocker, and ACE inhibitor. The discussion covers the pathophysiology, risk factors, diagnosis, and treatment of NSTEMI.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    95 views28 pages

    PPT

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    uculucull
    This case report summarizes a 62-year-old female patient presenting with chest pain. She has a history of hypertension and dyslipidemia. Initial ECG shows ST depression and elevated cardiac markers consistent with a non-ST elevation myocardial infarction. She is diagnosed with NSTEMI and treated medically with aspirin, clopidogrel, statin, beta-blocker, and ACE inhibitor. The discussion covers the pathophysiology, risk factors, diagnosis, and treatment of NSTEMI.

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    of 28

    NON-ST ELEVATION

    MYOCARDIAL INFARCTION
    ANDI NUZUL JUMHARI
    C111 13 501

    SUPERVISOR :
    dr. Akhtar Fajar M, Sp.JP, FIHA

    DEPARTMENT OF CARDIOLOGY AND VASCULAR MEDICINE


    MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
    MAKASSAR
    2018
    1
    Agenda

    1 CASE REPORT

    DISCUSSION
    2 NON-ST ELEVATION MYOCARDIAL INFARCTION
    2

    Case report
    Non-st elevation myocardial infarction
    3
    PATIENT IDENTITY
    Name : NY. SU
    Age : 62 years old
    Address : Mamuju
    MR : 257220
    Date of Admision : February 24th 2018
    4 HISTORY TAKING
    Case report – Ny. SU, NSTEMI

    Chief complaint : C
    A Chest pain

    Present Illness History :


    B Chest pain is felt 7 hours before admitted to the hospital. Chest pain as pressured on her
    left chest with duration more than 20 minutes.
    At that time the patient was awakened at 01.00 am due to chest pain caused,Chest pain
    radiated to the left arm and shoulder.
    the patient consumed nitrate once but the chest pain did not subsided
    Cold sweat (+) , Dyspnea on effort (-), Ortopneu (-), Paroxysmal noctural dypsneu (-),
    cough (-), Nausea (+) vomiting (-), epigastric pain (+).
    Defecation and urination is normal.
    5 HISTORY TAKING
    Case report – Ny. SU, NSTEMI

    Past Illness History :


     History of Hypertention (+) from 2007,
    take medicine regularly.
     Dislipidemia (+),
     History of previous chest pain (+), from 2007
     History of diabetes melitus (-)
     Family history of heart disease (+)
     Family history of hypertention (+)
     Family history of dislipidemia (+)
    6 HISTORY TAKING
    Case report – Ny. SU, NSTEMI

    Personal History :
     History of alcohol consumption (-)
     History of smoking (-)
    7 HISTORY TAKING
    Case report – Ny. SU, NSTEMI

    Personal History :
    General Appearance :
    Moderate illness / overweight/ Composmentis

    Vital Sign :
    • Blood Pressure : 123/75 mmHg
    • Pulse : 107 bpm, regular
    • Respiratory rate : 20 tpm
    • Body temperature : 36,0º C

    Head Examination :
    • Eyes : anemia(-), icterus(-),
    • Lip: cyanosis(-)
    • Neck : JVP R+2 cmH20
    8 HISTORY TAKING
    Case report – Ny. SU, NSTEMI

    Personal History :
    General Appearance :
    Moderate illness / overweight/ Composmentis

    Vital Sign :
    • Blood Pressure : 123/75 mmHg
    • Pulse : 107 bpm, regular
    • Respiratory rate : 20 tpm
    • Body temperature : 36,0º C

    Head Examination :
    • Eyes : anemia(-), icterus(-),
    • Lip: cyanosis(-)
    • Neck : JVP R+2 cmH20
    9 HISTORY TAKING
    Case report – Ny. SU, NSTEMI
    Thoracic Examination :
    • Inspection : Symmetric left and right
    • Palpation : No mass, no tenderness
    • Percussion : Sonor
    • Auscultation : Breath Sound : vesicular, Rh -/-, wh -/-

    Cardiac Examination :
    • Inspection : Ictus Cordis wasn’t visible
    • Palpation : Ictus Cordis wasn’t palpable
    • Percussion : normal heart size
    •Upper border : left ICS II
    •Lower border : left ICS V
    •Right border : right parasternalis line
    •Left border : left medioclavicular line
    • Auscultation : Regular of I/II Heart Sound, no murmur
    10 HISTORY TAKING
    Case report – Ny. SU, NSTEMI

     Abdominal Examination :
    • Inspection : flat and following breath movement
    • Palpation : liver and spleen unpalpable
    • Percussion : Tympani
    • Auscultation : peristaltic sound (+) , normal

     Extremities :
    • Oedema pretibial -/-
    11 LABORATORY FINDINGS
    12 HISTORY TAKING
    Case report – Ny. SU, NSTEMI
    13 ELECTROCARDIOGRAPHY

    24/2/2018
    Rythm : sinus rhythm
    HR : 107 bpm
    Regularity : Reguler
    Axis : Normoaxis
    P wave : normal, 0.04 s
    PR interval : normal, 0.16s
    QRS Kompleks : 0.08 s, Pathologic Q - lead III
    ST segment : depresion I, aVL, and V3-V6
    elevation III, aVF
    T wave : 0.04 S
    Conclusion : sinus rythm, HR 107bpm regular, normoaxis, Non-ST elevation myocardial Infarcti
    on, Old Myocardial infarction
    14 ELECTROCARDIOGRAPHY

    25/2/2018
    Rythm : sinus rhythm QRS Kompleks : 0.08 s, Pathologic Q - lead III
    HR : 71 bpm ST segment : depresion I, aVL, and V3-V5
    elevation III, aVF
    Regularity : Reguler T wave : T inverted V1-V2
    Axis : Normoaxis
    P wave : normal, 0.06 s
    PR interval : normal, 0.12 s
    Conclusion : sinus rythm, HR 71 bpm regular, normoaxis, Non-ST elevation myocardial Infarcti
    on, Old Myocardial infarction
    15 Diagnosis
    Case report – Ny. SU

    Non-ST elevation Myocard Infark


    Hipertensive Heart Disease
    16 TREATMENT
    Case report – Ny. SU, NSTEMI

    • Bed Rest
    • IVFD NaCl 0.9% 500 cc/24h/IV
    • Aspilet 80 mg/24h/oral
    • Clopidogrel 75 mg/24h/oral
    • Atorvastatin 40mg/24h/oral
    • Farsorbid 10mg /8h/oral
    • Ramipril 2.5 mg/24h/oral
    • Arixtra 2.5mg/24h/subkutan
    • Bisoprolol 5mg/24h/oral
    17

    DISCUSSION
    Non-st elevation myocardial infarction
    18 DISCUSSION
    NON-ST ELEVATION MYCORD INFARCT

    • Acute coronary syndromes (ACS) comprise a spectrum of clinical conditions,


    initiated by rupture of an atherosclerotic coronary plaque
    with overlying acute thrombosis.
    • The consequences of thrombosis include direct obstruction of blood flow to the
    coronary beds, as well as distal embolization of the platelet-rich thrombus. Both
    of these processes may lead to myocardial ischemia and may progress to myoc
    yte necrosis and myocardial infarction.
    • Myocardial infaction caused by a critical imbalance between the oxygen supply
    and demand of the myocardium.
    19 DISCUSSION
    20 DISCUSSION
    ECG

    ST DEPRESSION T INVERTED
    21 PATHOFISIOLOGY
    Chest pain/chest dis
    22 comfort may also
    discribed as a dull Not fully
    pain, ‘pressure’, relieved by rest or
    squeezing’, or nitroglycerine
    ‘crushing sensation’
    or burning sensation
    Serum cardiac marker

    Ischemic symptoms ; Clinical elevations : CK-MB,


    TROPONIN T
    Dyspnea
    Diaphoresis Findings
    Nausea and vomitting

    Substernal chest
    pain/chest discom Duration of chest
    fort radiated to the pain 20 minutes
    left arm, shoulder,
    neck, jaw
    23 RISK FACTOR
    Discussion

    Modifiable Non-Modifiable

    • Smoking • Gender & Age


    • Hypertension • Men > 45 years old
    • Diabetes mellitus • Women > 55 years old
    • Hypercholesterolemia • Family history
    • Obesity • Heart disease in
    • Psychosocial stress biological brother or
    • Lack of physical activity father > 55 years old
    • Heart disease in
    biological sister or
    mother > 65 years old
    24
    DIAGNOSIS
    Discussion
    25 TREATMENT Plaque
    Discussion
    stabilization
    and secondary
    prevention
    Management
    Improved of ischemia Treatment of hypertension
    coronary and dyslipidemia . Tight
    Prevention of glycemic control in diabetic
    perfusion Pharmacologic: patients Smoking cessation,
    recurrent beta-blockers, nitrates, weight reduction, regular
    thrombosis Coronary morphine, calcium exercise Therapy for
    revascularization: balloon channel antagonists depression and anxiety
    Antiplatelet therapy: angioplasty, stenting, and
    aspirin, clopidogrel, adjunctive procedures,
    glycoprotein IIb/Iia coronary artery bypass
    inhibitors grafting
    Antithrombin therapy:
    unfractionated or low
    molecular weight
    heparins, direct thrombin
    inhibitors
    26 TREATMENT
    Thank you

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