1 ANNUNNERUREEEE EEE EEC C COCO EEEEEDTETIEE > Satu spectrum, manipettan akut dan berat yang merupakan Keadaan kegawat- _damratan gan Korner akibat dan oltiran_darah. __plbrur yang menuiups plat fenebut. Agregass trombortt aan | Petepaion 20% voroatne |» vaiokenrtnet > Alron darah koroner bernurang aktvan yatur kogguiat | _Menyumbat liagg PD koroner nc keraak rembangan antara_Kebutuhan O2 miokeraium Tesentur temeur yang Kaye trombottt hte trombur) _ —Uterat épartiot) PD yang _teotn autor }-memperberak_gangguan_aliran __ __darah rorener_ = Scanned with CamScannerIkEMIA MIDKARD —> Behentinya patokan On t20ment —> Miokara tum _nesrosis ee eee : : eee miokaretiam = INFARK MIOKARD = ~ Geteah temo _hilang) - duritrmia, _ : — Benrule ventrike] dan remodeling vente _ C(perubaran) ae Fungu ventnke! * feragian patien SKA Kaok mepgatam reyar piak « SKA Karene obttukti_ainamie aakiont Spoime (okat dan A: Koronote eptkarctal_ CAngino _pnnamerat) “ ~ Pregress_piak/rertencny_feteiah PCI_—> penyempitan _A:Koronon@ rtanpo _tposr ae Foktor etsenntie pencetur ACH + demam anemia -firfokrikony «hipotenn, brocirerci Infor: moore akut dengan {T-etevou CIMA-!T) = Inpork miokard akut_nen= erevon segmen JT UIMA=NELT) =N STEM) Angina. pertors taax tabi cuAP) _ STEMI + V Inaieater Kgacian .oktun total PD_A-korener unui mengembatikan aliran sarah can __secepataya. Crevateaianon tat menurgge hon) ee) oS Mebicamentora: fuer i v_ Metanns PC! CRercutaneur Coronary tnservention) "BSS~ ~ ~ ~ ~ ~ =~ ~ = ~ ARERR RR ERREEEREE LEE ELEY /Diagnonr: keuhan angina pertonr akut + eleven regmen JT et 2 (eag bepareggan.- ACUTE CORONARY cYNDROME. WSTEM) i step le egging Gow * a Demand _tuchema, no inporct /Supyy wchemva -no inparct ” “Subendecarciat tmgarct” + Kebutuhan miokardt +. _|+Tegaci_ruptur piak dan [+ Tyna oki total PD feropi_ PD Kaak ctkup feventute frombur aueritor Spkeruiakan dan ingore berctiatarr untuk. dapat | plak yong ruptur. —> oti | miokarciuen subencterar— Meygaurkan.damh yar |. parnal_PD. ws At aval aaeruat u/memenuhy + Tegasi toat_whrahat, __Kesutuhan mioxoret, Hoa" aaiam waktu yary negket | —__ a || A oormai) ta a fol yh a {note 7 tmeriea [hz ee ‘a 36 depten come N _ {Toponsn aN 7 ANA /- pa STranmurat ingore” Hiporap eT STH evar + Ortun Jeompin PD —9 keruiaken tranimural dan ingore mipkaretiom _ Abnormal EFS dan troponin T “Bes Scanned with CamScannerJ Diagnow, + akeuhan _apging peetenr orcur + ¢T=eteva! Ada. aeprenn regmen ST ne J Troponin 1 VAP + ¥ Tata ate Troponin ¥ Ok(u_fornar Divedaken dan biiiarke Jomtung (High semivigy troponin strepean, Cama) - BES noma _ + tea, ERG _awal norma /ketainan nen=aiggnoitis dan aggine maith. verengrung —s Ferval to-aomentt log. —» ERG marth same, Retuhan saqgat "egertip ACL —panray 12-24 / gammy tang setap_aggine berutang. /retroakgys 2s j9m 2 - _ Nyen_ aada khan inparte = = Nyen dada berot diveatang Hemet kin /perreqgahan dada , meejaiar_Reteker. fohorg - i _——_patrgguing angen fe, z = Nyen_atrorazan > gomenie __ - __~ Nyer trate berturagg Agyan UHrahes ___ _= Nyen durertar_renggat dingin, muat, mun rab —Metanume qyert_dacte_pade AY 7 - Okt PD _—> Otokjantacy ukemi — metabolume meyjaett_anceree —)- __loktar, herofonin, _ WYER c— Mengarnptean ‘epter < _eaenonin DADA ert auarop (72 Ty Uegjaaron tua asrnaten) “Bess Scanned with CamScanner~ y 5 \ N ~ > ~ S ~ ~ ~ ~ ~~ ~ ~~ ~ CUCU RGREEEEEEEEEEES a Ayer dira@kan dyerras keringet oft ‘Alaphereur Nyon aaa menimbutkan __Sarap_nmpatite = toute cingin Fafa. faple qyaman _meteparkan Fatelcotamin \ ‘ult (@mbole bags — — —— + Anamnens) - Nyen aso | Tipticat_Cangina_tptkat) > v Rata terteran “beret daeroh rerrorternat, her, rahang inter __fkepuiar, bahu, epigaitaum. —________ meyypter_tretengan fin tel || - ¥ Intermitten Chebercpe mente) Z pecruren (220m) Y Duertar kenngat stingin. mual/mentah, ayer ———— abdominal, 18k ASpat, shkep. —_______ Atipirat Congine sxtipizal) + V Unto made (25-40 tha) atau anne ¢>7Pths), aeons B-DM.- gagat_ giyel_menahun » aemen = _ eee 7 Ngen_siageroh _pryararan aggina_ tpt eta: nopos yang sunt atteraggkan , rarer (emah mendadak yang rut aitraikan Meurer 7, BERD GUT Erophagest psy Utkur pepteum Coitechenanty + Mureuto Copraxtur corrae a 4 Scanned with CamScannerScanned with CamScannerWNRRRRERRRER ERR EKEESSEEEHCEEOCHH HHH HEH HHO Nitar Zrange troponin berbeda sop tabi a __ tng dm) Bxtoo * Borsertine Reve ot _TFeponin 1 . a Tidak Ke v. 7 l . Rate in Rute out/ borertine | Aparah memenubs foe st __|__garbone 2 Chnterio ppaiere | seeaeee Onvernyer < gam __Less) _ > yam? L Cee wiagg_§ yam (99! ges tee Troponin T__Troponin tL N=s TEM! VAP _Doestenn Dx teria Scanned with CamScannerbate (gactota Crtere por LBBB > __=> STeetevon_ imm_konkerdanr dengan tompiers GPF C+) + (a) ST aepren 2% 1mm ronkordanr peda Vi-V3_(icore a) Cb) ST etevor_y Smm _dukonkercton pada radapan dengan rompiers ORI ( Lire 2) Ce) Contoraont ST eleven pimm 5 pode (eae deygan Kompiers ORI aN — W) teres + Pementioan Bute «| ; _ ovate mengiaentsprcasn p> fotetor_pencetur ireemia - Kompitean_(reeme —> pense MR akut, (3, renehs bach Penyeit pequerta haar hiperenr, _ ue _freayingrirteor DD " ew Kieatinn kinare CCE=M8) > « Biomarke ee Cont Cgeia: troponin Normal doiam @=GJam sttetah auitan —> ulang: 8~iayam_terelah_awinan. _1 Troponin: Taworoh_penper_2~yam_tereiah auitan emenetap tampay 2 mieggu 4 CR-MB + Taoiam Ab yam_cfuneakeys yam -menetap sampay 2 mings. « Angiegrops_foroner| a UF avagnoriae potien_RerTi_dan DP/.yogg Mak Jeter _ Anguegrop: thar: etientriror baton Ireguter culteran « penamparo, YaQg Rabun, Filling _agpect , “Gass Scanned with CamScannerANY VUVUEvesesee ree me - Keran: trombur intrakerene@e okIWh total ai LAD. ——— Horus fegera dltacurop ——— Topons 2 steggion bear T ~> betagyat meas: MI fanpa ST-etevan «9 sehiggga powen aeqgan EEC diegnortik STEMI dapat regero: ctireperpun ranpe menunggy hat! roponin- = STeevon Leas Va-Us = Ty o-1mY duemua (ead kewau Va~Uy + 2-amV_poaa tak" 40 tha + %.0,armV padatakt” <0 tahun + %oAsmv paso @ Geotoh gambaron sT-etvan pace Mi: cove a rh ___Sifagint unttopping ft hf ty siraght herwental Scanned with CamScannerEe ihe fire == Tao : VAP _ _ Stetipea reno pace NSTEM) i Z = Tyyuans_u/menentucan stateg: penagganan seaqyutnya Cronvervanip_/invaip) — 2 Strofipivou cinco NITEML : Timi aan GRACE + TIM C_Theombetytr im MU Parameter 1. Une > 65 tahun |e Angiegram Koroner sebeiumyye menugwurtkan sfenon > = Pengguncan onpirin eocom 7 han teratchir ferorhir nas ———____ &- Deviott JT >1mm Joa tbo 2 Pening kerton bromorea yantung (CK, troponin) _ Srratypsvats a ¥_O-2 Cruike renctah) 42. Leth aor a faktor miico LHT-DM, merokek -RPK «dutiprtemia) | ~ _ §- Seraaeaye Depuste Ayer foat UiEahar salam sa jam | Scanned with CamScannerate ‘epee + GRACE: U/memprecieit mortedttar tom| Orrasssiee tor | ; 40at perawatin ARP dan 6 buien 5 Fetelah ketuar aan RL —. . Steesee . - . [@mmswaa uw) | + Vonebets ~ | Ure = Kp | = HR = Heo jantang yp | i. 1yo__* aggi_ 3%) coat) _ Bantig_* menengah (3-8%) _ _ ___+ Preawens Goutan reteiah betuar RE F C88 * senda UB tng (28%) 1s Taak teaopat HF CRhatau S38 (-1) — = Ms Teraapat HP _deqgan J8 Ut) aan Ronehr (4) at Ye tap. poru WW: “Teraapat edema pary attandar Rh barah aewruh ap-pary Wt Terdopat gyok tarctegenite teagan TOS <30 mmitg tan Aupoperrun cjanggan 1 a Sionptors me | ee _ _ | Porgy mentor don 66 | ee ee —— “PERKI 2018 RipoRremng —C-Sa02 egy Cer sae -pasonggne <9 |—? afeu Meds Gommg J ot 7 Tarvonas Mepnne Orggee Nugien “00 Arrmn| oO, —____— Fee pe ae | Loaaing aypinn 160~320mg fe anasspratetet] . Clopretegre!_s00~b00.mq Scanned with CamScannerANN NRE CCC EEE ECO OOHEEEE EEE Menghambat akhvitar @naim Com danE sos 27 ya0g = Felagyureyo mepghambot __ | _prectutss prom boron 2 propstaks peqyakit serebroveniuler/ MI Hiperiensetivttar - atma, taka _ __peptit, yong atktip « hemopie dan oo : — ®*BRIUNTA @=s ——— gprgguen_perctarahon tain, _ ticagrelor unt, menqut —/Meajramvar rereprer Aetenosun Dissiget, —~ hermits menysuet Vleagheamb P bee ES brontetsparmesmual emuntah lo : : f y 2 chor) ____ yer -utterats perterah an I Placta(Z))ns omeragy —___taturon cern -tomborttopents Sanh wt, Clopidogrel Fenner tata poven Racana reperpigy "=" [= Meneggah_tromboru pase ACS | _ Mey fone reps) KL = Ct. pertarahon anne chipertenune | _ treverrber EL= aupnea. perdarohan..somr repata, | | = Mencegah tejadian atero¢romboru pasta Ml, bette, temor- ponigg, AF, HT, qyert fi __ ACE CsTemi. turret VAP) dove nen-kardiak , arare, ayer IK I> Hiperenntivitor, perdarahan_aktip /perdarahen pnggung dit {___tnfrotroncay_chamt Doi — toacigg (80g -atequtkan | ES> Diipepnia, qyen_perut ediore, perdorakan , ail _2xe0mg chan —______E Dorie = pemetiharoan 1789 Char Secioan -» Tao gongs Brine _| Sectiacin = tabler 15mg ~» Artepie, Clegin, C —_{ Sepraager- topan seth copter + CP6. - | pidovvr. plocte - placer. plactegee! - pater - { plovir plover, vocto “Besg) ~— Seanned with CamScanneri — — PC ateeginees cnt) atau DN SL ____31g_-maknmat_3x_ (dopat at ____ aagg, 1ekeap_smentt) _Meanirme_ eat Lemay dan rupias 02 degen wre _mempepg.arubt _tonur vorkuler } — vorcattaror yoinuier > _ ! auiran bau Fyanturg b> pretoad < — Keburuhon oi \ Konfroinarton: ~Hiporentr Tarwarat / braciparor tag = Riwgyat minum obar Rust Cirenapil 24) Taaatapil as) Seaoan > SL + tame bays to-bomentt + Tab 5mq_( tedocara » Parterbit -UOket, UOrbit) tomg_- loner rererres | ___* Dowr IS~Bomg than cttbagi w-3conr Inpur (V+ Cesocard tng émi_- parroreid mg/m) — Dorr teaearmg Kam Xone “_Mutrgginenn #_mesaniime _ Cine SLs Tab ofsmg Coitrat) Dong + fabmivo! aivawan Moh Clame beyato~s0m) Lore: nitrorat retard fab sity) + nitotar porte Cas meg) 2 donr 2g Aeon Ca~$7hon) Scanned with CamScanner™ ~ ~ ~ ~ f ~~ ~ ~ ~ ~ : : ss —_! — — ss ss —~ 7 4 7 NTE dnp (0-200 meq Zmenit ATAU UNV anp 10% Gam OV ets sg upate 2AM | sce ¢ Puaiuary Ktmenit, bua ax bOlur Dept ctwany 30 mench . — __ Eh stuiciny setrap 0-30 mente RZ Arpiin toe 80mg No-t P/ ADM tab omg No. It P' 4 vm im _Cleupyan) tm Catbawah titan) Xe oe __Y Nitreguena tab areg No. 2 ime Chawah dor) FY Teagreior tab Boy No-i oe St ZL ee PY Morpin amp tomy fn) 0-1 ; ee ——dpue see No fang R/ Clopragret tub 7514 Nov Lim ro “BESS Scanned with CamScannernoxaparin SS] ‘Apiaaban Te Ederaten | fondeparinw , ——— ——S rivaroxaban { /Bivatiruain VKA a on Dabigatran sae ae ———— — ™ | rerum _ J re ar congener FHL (meson) caeade _ Ale g ————— Dovecmeruorray | & [ tae oy Grimm rcetor | epiare | Gpuwrntainnicrss| Or aoe i — Teseror || “Sercan | i _ Esmereer | aoe) 3—— Gay gam /rhen edeipat memes PCI <9° menin tga ferngg tian aie, dan ontore meair perrame hitgge fereramon EKG petrama Sto ment wephepurts + Werte fuegge_teraps + Waktu dar Kontat _peroms ¥_ Fiennourir + £30 mente 7 VP pamers yam \_ _d J , i ’ : a _ i 2 Rerowr seymen fT Dengan bation , Hear atau aiat (ain - dikggaran page oer Yoeg Inport fanpo “pibanditie sepeiumaya. 7 daiam wort 120 ment can KMP (Kontak Meau Perroma) —— ‘d aqgan fade: exten yagg okiut fora! >ayjam_feretah aver —__Fggiaia paste paren srabit_fanpe grate treme ¢ bawe ete betum_ctibenken Hereipl pienneltii. rdap ferapr annprareter gance _—» pith. Drug _.etitens Bile teak Kite stents (DES) danpada Gare meray stents (Mr) Fametotgg peuproreaure! POL pre > Terepr_antipraterer ganta_—»(Arpinn) + _peaghameat Fetepto.< Abe. | wb - (0S) ey Teagretor Cleoung (Beng _ Aiveeg ian: - ____femettnaraan 90mg ami) -ATAV = Unprochones Hepone CUPH) ______Clepusagret leasing 20mg. 7 —_-Broxaponn Vo pemetharncin_ iting) = Ponaeporinux _ Fiounotetts War Wolktu dan fenks — Lengrath + Uioktu_rgare autian ggyate Ce Hyam/>Iajam cléqgon tanda:dan.ggjata tewemin) + Ruiko piennotuir can indikon Kents. plonneline + Wokow yang. sibutuhkan 4/pemindahan fepuiat keiehatan yong amp metakukan UP “PCL. Scanned with CamScanner a x ALARA AARIDAAIAAPAAAAFAMPMFEFAMAAAIIAIAVAAAATRAAAYDate 6) 55 ___Langieah 2: Tenturan pithan yoarg (ebth bark ¢piorinotint / Aroegi rnvarp £24 ea Gtrategr invorip 1 Terreaia_catth (exb_deggan aueung “an_pembeaahan: - + Watt anjaro.eentar mestir _Frorineatar + Ronen aatang < §yam.feretah auton ggaie tade Kendote __untute ffrarggy tnvonip. _ _2. {trateg: tnverip_fetak dapat diiaxuken * _¥ Gath-tab fedong Choiak dapat aipaker Y_ Keruiton_mendapaticon aktes voteutar aepgan batonuan /Qeor-to- falteon ayam seretah door -to- needie > Gomenit. _V Urarty antaro ERE aiggnottils tampas “wwe _efonng 290mentt. aurten S-Deggnows STEMI mah rage” fegere tenon ac (6D _ untuk meminimelnie Bio tetah auputureon febnnotity ___eteriambotan _‘eperpurr. 2 met = C1) SHreprormore CPE) _ a = Dem aval + iS gute U. datam tome D&S, atau farutan faline 03%, talon __ Waktu a0-Gomentt — : ~ Bey Scanned with CamScannerCa) Alteptote C#Pa) aeiioe Dom awats Bolur 1s mg lV OrF5.g kg. Ferama_somenit - hennaian ou __Seiama_Go_mentt - Dory tote! fraak 7100.99 (3) Teneetepiare : _ ae Dom tugggat_bolur (V feruar BB . atbenkon retame Stefi: __+ <60kg + 30mg 7 - + bo TOKy + 35mg __. = = aoe + To-Bokg * 4omg aa _ - ne — + Bo-gotg + 45m - = - - + 7aokg 3 Seg = Ki Fbnnoine,——> Abrout: = Strore nemoragie Cerote yang _prryseabrye betwm _aiketohur - dengan oution .kopanpun _= Stroke uemie @buian teroRIT_berangiung > em = Kentiatcan turtim rarop _sentrot don neoptaine ~ Troume operon / fraumo Kepoie _berat ctatam 5 minggu_feratehir. = Pemorohon_aniron cena tan _terakhies = Penyarit perstorohan _ = Duen apie = TA datam 6 bwan terakhie = Pemakaian antikegguian orol oe = Kehamuan / ¢ mpgge port partum = Tempo turuwan yang nook dopa arom pr — Rewuntan troumate ~ HT teprontee (TOP >itommig) _= Pega) hate loyur ~Inpetn enacraraunsy —Ulorpeptikum oknp Scanned with CamScannerPCI poco _NSTEMI Hotes: mvonp: = Srategy_nvor vey = regere Ce gjam) 2 High atk tampa menghiouron EXE & biemorice ca Sasor —9reperpun rgyer __ Koma —>pementiaan nen- korean —) dotan ditemu ~ Kan penyebab enki janring non~reroner —> “Agegraps toroner”Date = Ftraregr_tnvonip ain (cay jam) —9 Angtegropr ataiam ayyam feretah paler lpta mutes menuimpure chtunike eakms © Haropatyy erage + menont eerubah mec: makropag dan meqgeterenrcn retepter cawvonger yarg benbatan deqgan LOL —» manropeg berubsh menach oom cel p 7 Heyaar Injrabiutar tapuan prague akwot plamon yang menumpur © Ruprure Of prorour cap => feptur krninftabittar —> femenrure tHhrembur einpark (=) -nekrorir -) park CH -nekrons (=) STEMI + tinemits C4). inpacte C4. NekronE CH) I INFARK C NiTemi 7 Stem sevagion Current) YL sevuranaye (sTEM) cJitefudah nekrony . jetak dopar tipersaite Currevernioet) “BESy5 ¥ ——_Inpark_bertaggiug > 20-0 ment ~>leeruianan (revere) __” i __Nstemt ( Subenctocacated “Tee =n > pores maith bout eS ome Se koroner «yang Fertutups oleh trembur Eke : |. Aer - a Lingarct) = en endocardium ts fh. Cieteah 3-4 yam) VE Yi UY, “Tranimured inparet: _demua area rustah impart. Gs Pepa 20 Se _ A skoroner_terturups leh fromeur stem (Te we Pf XN ST eevenUtkemik ,namun belum inpark. Znekeo tte — Manh reverribey Jika 02 rerpenubi_Remeale _Peurahon Posca_inporis _ _ , ingore tops eum nero | Oe € 20-40 menit) 7 Kerusenan Ureverncer | Jo. fusiah_nerrons _ _ - 7 hoo aS - - | SS “Contraction Bana Necrosis” _ ' Keagaon_oimana soar _igyaai_reperpur « tegadt mptux Ca | manive paca rt yong teiah Nerrot. senngg & rer renebut “matt daiem bentue "kontrarte”. Vermnet Kin CLV), Lap (Lepr frat ercenst Lex Atvecy 2 re eae = Menaoron_ainsng_ontensr oe ’ Hon eee ee (ay = 40-50, Katut inpark — Okws UL AD 1 tegen IT = Ditanctar_peruea! a Vy “ (BESS) Scanned with CamScanner+ RCA Rght cornaey Arte): = Mensatohr ainaigy inpener - atrium esinos = 30-4e/, row. a z GRY. aan sifting port” = Pecubahan regmen $T th rill ave , ave yr-Vo v4 + LOX (Lepe Careumplere Artec) =Menaarah: dinaiag_(aterol wv = [b-1S "Rue _ = Perubahan fegmen ST ots |e ale veVe STEMI) > antero> 2 VU - Ly ansereseptat Vy eusbensig antence * Vive, ‘Leave - CG anrerctatero) > VE Ver, ave is inpentor Th pti, ave G yentneet ronan * YwR VER - REFERENCES = Perms Gueune ACE aoe aa ese a0 20 _ _ 5 ACLS Note. thaiamur rote , 4 . == Scanned with CamScanner