Assessing Chest painCharacterTime of onset, duration, frequencyChanges in tempoExacerbating and alleviating factorsPain during situation associated with increased myocardial O2 demand ( e.g. exertion, stress )

SINDROM KORONER AKUTMerujuk pd sekumpulan keluhan dan tanda klinis yang sesuai dengan iskemia miokard akutMencakup Infark miokard akut ( dgn elevasi /depresi segmen ST , gelombang-Q dan non gel Q) dan angina tidak stabil ( UAP)Sindrom Koroner AkutTanpa elevasi STElevasi ST Infark Miokard AkutAngina Tdk Stabil NQMI Qw MINSTEMIKursus SKAk

Immediate Assessment in EDVital signs, including blood pressureOxygen saturationIV access12-leads ECGBrief, targeted history and physical exam (to identify reperfusion candidates)Fibrinolytic check list; check contraindicationsObtain initial cardiac markersPortable Chest X-ray < 30 min.Assess for the following :-Heart rate > 100 bpm and SBP < 100 mmHg-Pulmonary edema/rales or-Signs of shockIf any of these conditions is present, consider triage to a facility capable of cardiac catheterization and revascularization

Early Repolarisation !!!

LOKASI ISKEMIA BERDASARKAN PERUBAHAN DI SANDAPAN EKG SANDAPAN LOKASI ISKEMIA / INFARK II ,III, aVF Inferior V1,V2,V3 AnteroseptalV1-V4 Anterior V1- V6 Anterior ekstensif I,aVL ,V5,V6 Lateral I, V6 Apikal V7-V9 Posterior V4R Ventrikel kanan

Emergency Department (1)AMI Protocol-ECG screening within 10 minutes-Door-to-drug time < 30 minutes-Door-to-balloon time inflation < 90 minutes

For all patients with ischemic-type chest pain, provide supplementary oxygen, IV access, and continuous ECG monitoring

Emergency Department (2)Reperfusion therapy for ST-segment elevation MI (STEMI)- Rule out contraindications and assess risk-benefit ratio. -Consider PCI if ineligible for fibrinolytics-angiography for cardiogenic shock (angioplasty or CABG if indicated)

Prompt aspirin (160-325 mg) for all patients with AMI who are reperfusion candidates.

Emergency Department (3)Beta-blockers for all patients without contraindications.

IV nitroglycerin for initial 24-48 hrs in patients with AMI and CHF, large anterior infarction, persistent ischemia, or hypertension.

FibrinolyticsAbsolute Contraindications :

-Any prior intracranial hemorrhage (ICH)-Known structural cerebral vascular lesion (eg. AVM)-Known malignant intracranial neoplasma-Ischemic stroke within 3 month EXCEPT acute ischemic stroke within 3 hrs-Suspected aortic dissection-Active bleeding or bleeding diasthesis-Significant closed head trauma or facial trauma within 3 months

FibrinolyticRelative Contraindications :- Check your handbook !!!

Thank you

Ischemic EKG changes; T wave inversions anterolateral leads