Introduction ACS
-
Upload
vivi-anggelia-ang -
Category
Documents
-
view
232 -
download
0
description
Transcript of Introduction ACS
![Page 1: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/1.jpg)
Yeo Hans Cahyadi Yeo Hans Cahyadi MD PhDMD PhD FESC FESC
Born: Jakarta, 24 August 1955Born: Jakarta, 24 August 1955Status: Married, 3 childrenStatus: Married, 3 childrenEducation: High school, Budi Mulia, 1973Education: High school, Budi Mulia, 1973
GP, University of Indonesia, 1980 GP, University of Indonesia, 1980 Cardiologist, Kanazawa Med University, Japan,1991 Cardiologist, Kanazawa Med University, Japan,1991 PhD, Kanazawa Medical University, Japan, 1991PhD, Kanazawa Medical University, Japan, 1991
Fellow of European Society of Cardiology (FESC), 2007Fellow of European Society of Cardiology (FESC), 2007Employment:Employment:
Primary Health Care, Kalimantan 1980-1984Primary Health Care, Kalimantan 1980-1984 GP in Husada Hospital 1984-1986GP in Husada Hospital 1984-1986 Cardiologist, Husada Hospital 1991-now Cardiologist, Husada Hospital 1991-now President Director of Husada Hospital 1999-2005President Director of Husada Hospital 1999-2005 Head of Depart of Cardiology, Husada Hospital 1999-nowHead of Depart of Cardiology, Husada Hospital 1999-now
![Page 2: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/2.jpg)
Kegawatdaruratan Jatung Kegawatdaruratan Jatung Infark Miokard AkutInfark Miokard Akut
Dr. Yeo Hans Cahyadi PhD, SpJP, FIHA, FESCDr. Yeo Hans Cahyadi PhD, SpJP, FIHA, FESC
![Page 3: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/3.jpg)
![Page 4: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/4.jpg)
![Page 5: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/5.jpg)
![Page 6: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/6.jpg)
![Page 7: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/7.jpg)
![Page 8: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/8.jpg)
![Page 9: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/9.jpg)
![Page 10: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/10.jpg)
![Page 11: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/11.jpg)
![Page 12: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/12.jpg)
![Page 13: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/13.jpg)
![Page 14: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/14.jpg)
![Page 15: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/15.jpg)
![Page 16: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/16.jpg)
![Page 17: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/17.jpg)
![Page 18: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/18.jpg)
![Page 19: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/19.jpg)
![Page 20: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/20.jpg)
![Page 21: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/21.jpg)
Normal ECGNormal ECG
![Page 22: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/22.jpg)
VES (Ventricular Extra-Systole)VES (Ventricular Extra-Systole)
![Page 23: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/23.jpg)
VES (Ventricular Extra-systole)pada Old Antero-septal MI
![Page 24: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/24.jpg)
Anterior-inferior STEMI
![Page 25: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/25.jpg)
VT (Ventricular Tachycardia)
![Page 26: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/26.jpg)
Ventricular Fibrillation
Cardiac Arrest
![Page 27: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/27.jpg)
DefibrillatorDefibrillator
![Page 28: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/28.jpg)
ATHEROSCLEROSIS
INTRAPLAGUE THROMBUS
![Page 29: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/29.jpg)
PLAGUE RUPTURE
INTRALUMINAL THROBUS
![Page 30: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/30.jpg)
PLAGUE RUPTURE
PROPAGATION THROMBUS
![Page 31: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/31.jpg)
The Vulnerable Plaque
![Page 32: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/32.jpg)
Plaque Disruption
![Page 33: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/33.jpg)
![Page 34: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/34.jpg)
3434
1990199219941996199820002002
1990ACC/AHA
AMI R.
Gunnar
1994AHCPR/NHLBI
UA E. Braunwald 1996 1999
Rev Upd ACC/AHA AMI T. Ryan
2004 2007 Rev Upd ACC/AHA STEMI E. Antman
2000 2002 2007 Rev Upd RevACC/AHA UA/NSTEMI E. Braunwald; J. Anderson
20042007
Evolution of Guidelines for ACS
2009
2009Upd
ACC/AHA STEMI/PCIF. Kushner
![Page 35: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/35.jpg)
Pathway: Triage and Transfer for PCI (in STEMI)Pathway: Triage and Transfer for PCI (in STEMI)
2009 STEMI Focused Update. Appendix 5
STEMI patient who is acandidate for reperfusion
Initially seen at a PCIcapable facility
Initially seen at a non-PCIcapable facility
Send to Cath Lab for primary PCI(Class I, LOE:A)
Transfer for primary PCI(Class I, LOE:A)
Initial Treatmentwith fibrinolytictherapy (Class 1, LOE:A)
Prep antithrombotic (anticoagulantplus antiplatelet) regimen
Diagnostic angio
Medicaltherapy only
PCI CABG
NOT HIGH RISK
Transfer to a PCI facility may be considered (Class IIb, LOE:C), especially if ischemic symptoms persist and failure to reperfuse is suspected
HIGH RISKTransfer to a PCI facility is reasonable for early diagnostic angio & possible PCI or CABG (Class IIa, LOE:B),
High-risk patients as defined by 2007 STEMI Focused Update should undergo cath (Class 1: LOE B)
At PCI facility, evaluate for timing of diagnostic angio
![Page 36: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/36.jpg)
![Page 37: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/37.jpg)
![Page 38: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/38.jpg)
![Page 39: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/39.jpg)
![Page 40: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/40.jpg)
Mr. SS, 23-03-2011 (9 Ms post PCI)Mr. SS, 23-03-2011 (9 Ms post PCI)
Angina PectorisAngina Pectoris
Cardiogenic shock, BP 85/65 mmHgCardiogenic shock, BP 85/65 mmHg
ECGECG
![Page 41: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/41.jpg)
Mr. SS, ECG pre Primary PCI
![Page 42: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/42.jpg)
Mr. SS, CAG + Primary PCIMr. SS, CAG + Primary PCI
![Page 43: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/43.jpg)
Mr. SS, Primary PCIMr. SS, Primary PCI
![Page 44: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/44.jpg)
Mr. SS, ECG post Primary PCI
![Page 45: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/45.jpg)
![Page 46: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/46.jpg)
![Page 47: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/47.jpg)
![Page 48: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/48.jpg)
![Page 49: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/49.jpg)
Time is MoneyTime is Money
![Page 50: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/50.jpg)
Time is Time is MyocardiumMyocardium
![Page 51: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/51.jpg)
![Page 52: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/52.jpg)
Copyright restrictions may apply.Kim, K. P. et al. Arch Intern Med 2009;169:1188-1194.
Estimated lifetime risk of radiation-induced cancer per 100 000 persons from a single computed tomographic scan to assess coronary artery calcification by age at screening
![Page 53: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/53.jpg)
Copyright restrictions may apply.Kim, K. P. et al. Arch Intern Med 2009;169:1188-1194.
Site-Specific Estimates of the Lifetime Risk of Radiation-Induced Cancer From a Single Coronary Artery Calcification Computed Tomographic Screen at Age 55 Years
![Page 54: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/54.jpg)
Thank youThank you
![Page 55: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/55.jpg)
![Page 56: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/56.jpg)
![Page 57: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/57.jpg)
![Page 58: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/58.jpg)
![Page 59: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/59.jpg)
![Page 60: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/60.jpg)
![Page 61: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/61.jpg)
![Page 62: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/62.jpg)
![Page 63: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/63.jpg)
![Page 64: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/64.jpg)
![Page 65: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/65.jpg)
![Page 66: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/66.jpg)
6666
ACC/AHA 2009 STEMI/PCI Guidelines ACC/AHA 2009 STEMI/PCI Guidelines Focused Update Focused Update
Based on the ACC/AHA Guidelines for the Management of Patients With ST-Elevation
Myocardial Infarction (STEMI) and the ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (PCI): A Report of the ACC/AHA Task Force on Practice Guidelines
![Page 67: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/67.jpg)
6767
Class I Benefit >>> Risk
Procedure/ Treatment SHOULD be performed/ administered
Class IIa Benefit >> RiskAdditional studies with focused objectives needed
IT IS REASONABLE to perform procedure/administer treatment
Class IIb Benefit ≥ RiskAdditional studies with broad objectives needed; Additional registry data would be helpful
Procedure/Treatment MAY BE CONSIDERED
Class III Risk ≥ BenefitNo additional studies needed
Procedure/Treatment should NOT be performed/administered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL
shouldis recommendedis indicatedis useful/effective/
beneficial
is reasonablecan be useful/effective/
beneficialis probably recommended
or indicated
may/might be consideredmay/might be reasonableusefulness/effectiveness is
unknown /unclear/uncertain or not well established
is not recommendedis not indicatedshould notis not
useful/effective/beneficialmay be harmful
Applying Classification of Recommendations and Level of Evidence
![Page 68: Introduction ACS](https://reader036.fdocuments.net/reader036/viewer/2022081519/563db882550346aa9a94561f/html5/thumbnails/68.jpg)
Class I Benefit >>> Risk
Procedure/ Treatment SHOULD be performed/ administered
Class IIa Benefit >> RiskAdditional studies with focused objectives needed
IT IS REASONABLE to perform procedure/administer treatment
Class IIb Benefit ≥ RiskAdditional studies with broad objectives needed; Additional registry data would be helpful
Procedure/Treatment MAY BE CONSIDERED
Class III Risk ≥ BenefitNo additional studies needed
Procedure/Treatment should NOT be performed/administered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL
Applying Classification of Recommendations and Level of Evidence
Level A: Multiple populations evaluated; Data derived from multiple randomized clinical trials or meta-analyses
Level B: Limited populations evaluated. Data derived from a single randomized trial or non-randomized studies
Level C: Very limited populations evaluated. Only consensus opinion of experts, case studies, or standard-of-care.