JANTUNG KORONER/ ACUTE

CORONARY SYNDROME
Afifah Machlaurin
ISI MATERI
• Patofisiologi ACS
• Patofisiologi Atherosclerosis
• Pembagian ACS
• Terapi ACS
KLASIFIKASI ACS :
1. STEMI (ST-elevation MI )
2. NSTEMI (non-ST-elevation
MI )
3. UA (Unstable Angina)
 Acute Coronary Syndromes
Superfıcıal Nonocclusıve Ruptured Total
Critical stenosıs Fibrous cap occlusıon
erosıon
Platelet-
rich
Thrombus Fibrin-
rich
Thrombus

Non-ST-
Elevatıon ST-
Elevatıon

cTn↑
CK-MB- CK/MB↑
CK-MB - cTn↑
cTn -
NSTEMI MYOCARDİAL İNFARCTION
NQMI Q MI
USAP + High- RİSK
TANDA DAN GEJALA :
1. Chest Pain
• ”Elephant sitting on my chest”
chest
• > 20 minutes
• the neck, jaw, left shoulder and inner aspect of left arm
2. Shortness of breath,
3. nausea,
4. vomiting,
5. dizziness
DIAGNOSIS
HASIL ECG
1. STEMI (ST-elevation MI )
2. NSTEMI (non-ST-elevation
MI )
3. UA (Unstable Angina)
URL = 99th %tile of Reference Control Group

50
Multiples of the URL

20 Cardiac troponin after BIOMARKER

“classical” AMI
10 Blood samples for the
CK-MB after AMI measurement of cTn
5 should be drawn on first
Cardiac troponin after assessment (after >6-8h of
2 “microinfarction” AMİ onset).
Upper reference limit
1

0 1 2 3 4 5 6 7 8
Days After Onset of AMI
MANAJEMEN TERAPI
Summary of important delays and treatment goals in the management of acute ST-
segment elevation myocardial infarction:

• FMC- ECG and Diagnosıs: ≤ 10 min.

•PCI- Hospital: Door-to baloon: ≤90 min.
Early presentatıon
(Early presentatıon with
with large
large Mİ):
Mİ ≤60 min).
• Not-PCI-Hospital: FMC-Baloon: ≤120 min.
• FLT: Door (FMC)- Needle: ≤30 min.

SELECTION OF RP THERAPİES :
• Primary PCI is the recommended reperfusion therapy over fibrinolysis, if performed by an experienced
team within120 min of FMC.
• Primary PCI is indicated for patients with severe acute heart failure or cardiogenic shock, unless the
expected PCI related delay is not excessive and the patient presents early after symptom onset.
•FLT is recommended within 12 h of symptom onset in patients without contraindications, if primary PCI
cannot be performed by an experienced team within 120 min of FMC.Fibrin-specific fibrinolytics prefered
(Alteplase, Tenecteplase PA)
FIBRINOLYTIC THERAPY
• patients with STE ACS presenting within 12 hours of the onset
• Absolute contraindications to fibrinolytic therapy include:
– (1) active internal bleeding;
– (2) previous ICH at any time;
– (3) ischemic stroke within 3 months;
– (4) known intracranial neoplasm;
– (5) known structural vascular lesion;
– (6) suspected aortic dissection; and
– (7) significant closed head or facialtrauma within 3 months
FIBRINOLYTIC THERAPY
within 30 minutes from the time they present to the emergency department :
• ✓ Alteplase: 15-mg IV bolus followed by 0.75-mg/kg infusion (maximum
50 mg) over 30 minutes, followed by 0.5-mg/kg infusion (maximum 35 mg)
over 60 minutes (maximum dose 100 mg).
• ✓ Reteplase: 10 units IV over 2 minutes, followed 30 minutes later with
another 10 units IV over 2 minutes.
• ✓ Tenecteplase: A single IV bolus dose given over 5 seconds based on
patient weight: 30 mg if <60 kg; 35 mg if 60 to 69.9 kg; 40 mg if 70 to79.9
kg; 45 mg if 80 to 89.9 kg; and 50 mg if 90 kg or greater.
• ✓ Streptokinase: 1.5 million units in 50 mL of normal saline or 5%dextrose
in water IV over 60 minutes.
ANTITHR
OMBOTIC
to establısh
acute
reperfusıon
and maintain
sustain
patency