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ACUTE

CORONARY
SYNDROME

PATOFISIOLOGI SINDROM KORONER AKUT (ACS)

Unstabl
e
Plaque
in ACS

Plaque
(lipid rich
core,
fibrious cap)
Plaque rupture
deposition of platelet
aggregates, thrombosis

Partial
occlusion

Partial
occlusion
thrombolysis

thrombosis

Monocytes,
macrophages,
inflammation

Complete
occlusion
Collaterals

Lysis and repair


No symptoms

Unstable angina
Non Q wave MI

Q wave MI
Non Q-wave MI

Rapid progression of
atherosclerosis

Angina,ECG changes,
Troponin release

Angina,ECG changes,
Troponin release

Acute Coronary Syndrome

EKG:

ST Elevation (-)

ST Elevation (+)

Trop T (+)

UAP

NSTEMI/
Non-Q MI

STEMI/
Q MI

UAP: Unstable angina pectoris, Non-Q MI: Non-Q wave myocardial infarction
NSTEMI: Non ST-elevation myocardial infarction
STEMI: ST-elevation myocardial infarction, Q MI: Q wave myocardial infarction

KELUHAN UTAMA SINDROM KORONER AKUT


Sakit dada atau nyeri hulu hati yang berat, asalnya
non-traumatik, dengan ciri-ciri tipikal iskemia miokard
atau infark:
Dada bgn tengah/substernal rasa tertekan atau sakit
seperti diremas
Rasa sesak, berat/tertimpa beban ,
mencengkeram,
terbakar, sakit perut yg tdk dpt dijelaskan,
sendawa,
nyeri hulu hati
Penjalaran ke leher, rahang, bahu,
punggung atau 1
atau ke2 lengan
Disertai sesak
Disertai mual dan/atau muntah
Disertai berkeringat Start EKG

Psn Nyeri Dada


Rwyat nyeri dada
khas

Penatalaksanaa
n
SKA

SINDROM KORONER AKUT


Aspirin 300 mg dikunyah dan Nitrat s.l.

*
EKG 12
sandapan
Petanda
biokimia
EKG Non diagnostikPerubahan ST/T
Elevasi
Petanda biokimia (-)
Petanda biokimia (+)
seg ST
Nyeri dada (-)
Nyeri dada menetap

EKG tdk
berubah
Petanda(-)
Nyeri dada(-)

Observasi
EKG serial
Ulang petanda
6-12 jam stlh
onset nyeri

Rawat Terapi
Nitrat
ASA
APTS/NSTE
Clopidogrel
UFH/LMWH
MI
(+/- Antagonis
Receptor
GPIIb/IIIa
Malaysian Clinical Practice Guideline
on UA/NSTEMI 2002

dada*
Perubahan
Risiko rendahRisiko tinggi seg ST
Periksa di
Periksa
Petanda (+)
Rawat jalan segera
Nyeri dada
menetap
Pulang

Evaluasi
utk
reperfusi