8/16/2019 Ima Algoritme

1/19

 

Infark Miokard Akut 

8/16/2019 Ima Algoritme

2/19

 

SAKIT DADA ISKEMIK

Nilai dan tatalaksana segera (

$7A> 7A3G

Klinis

sta%il

erai trom%olitik * ili' :enis

ak ada kontra indikasi

$7A

rimer 

$7A* "aktu ti%a/la%*< .0 mntKateterisasi :antung*

 Anatomi teat untuk

reaskularisasi 8

EKG serial untuk

Indikasi terai trom%olitik

 Adaka' iskemia-In=ark ? @/12 :am 8

!easkularisasi•$7A

•7A3G

I77; *•erai sesuai indikasi•Serum serial

•EKG serial•E'o-radionuklir 

3ole'

!a"at :alan

5 kontrol

teratur 

a

? 12 :am

< 12 :am

 Atau alternati=

ekuialen

adk

dka

8/16/2019 Ima Algoritme

3/19

 

8/16/2019 Ima Algoritme

4/19

 

8/16/2019 Ima Algoritme

5/19

 

8/16/2019 Ima Algoritme

6/19

 

SAKIT DADA ISKEMIK

SAKIT DADA ISKEMIK

Nilai dan tatalaksana segera (

8/16/2019 Ima Algoritme

7/19 

9aktu se:ak sakit dada 89aktu se:ak sakit dada 8Nilai status klinisNilai status klinis

$ertim%angkan *•;nit E4 sakit dada•Serum serial

•EKG serial•E'o-radionuklir 

$ertim%angkan *•;nit E4 sakit dada•Serum serial•

EKG serial•E'o-radionuklir 

$ili' 7ara !eer=usi$ili' 7ara !eer=usi $asien risiko tinggi•Ge:ala meneta•Iskemia %erulang•$enurunan =ungsi

entrikel kiri•$eru%a'an EKG luas•3aru mengalami IMA>

$7A> 7A3G

$asien risiko tinggi•Ge:ala meneta•Iskemia %erulang•$enurunan =ungsi

entrikel kiri•$eru%a'an EKG luas•3aru mengalami IMA>

$7A> 7A3G

Klinis

sta%il

Klinis

sta%il

erai trom%olitik * ili' :enis

ak ada kontra indikasi

erai trom%olitik * ili' :enis

ak ada kontra indikasi

$7A

rimer 

$7A

rimer 

$7A* "aktu ti%a/la%*< .0 mnt$7A* "aktu ti%a/la%*< .0 mnt

Kateterisasi :antung*

 Anatomi teat untuk

reaskularisasi 8

Kateterisasi :antung*

 Anatomi teat untuk

reaskularisasi 8

 Adaka' iskemia-

In=ark ? @/12 :am 8

 Adaka' iskemia-

In=ark ? @/12 :am 8

!easkularisasi•$7A•7A3G

!easkularisasi•$7A•7A3G

I77; *•erai sesuai indikasi•Serum serial•EKG serial•E'o-radionuklir 

I77; *•erai sesuai indikasi•Serum serial•EKG serial•E'o-radionuklir 

3ole' !a"at :alan

5 kontrol teratur 

3ole' !a"at :alan

5 kontrol teratur 

> 12 jam

< 12 jam

 Atau alternati=

ekuialen

 Atau alternati=

ekuialen

 Ya

Tdk

Tdk Ya

8/16/2019 Ima Algoritme

8/19 

8/16/2019 Ima Algoritme

9/19 

8/16/2019 Ima Algoritme

10/19 

Assessing Chest pain

• Character

• Time of onset, duration, frequency

• Changes in tempo

• Exacerbating and alleviating factors

• Pain during situation associated withincreased myocardial ! demand" e#g# exertion, stress $

8/16/2019 Ima Algoritme

11/19 

Character of anginal pain

• Terlo%alisir terutama " tapi tida% selalu $ didaerah pre%ordium

• &enyebar %e lengan, leher, punggung,atau epi%ardium#

• 'ering terasa seperti mene%an,(constricting) atau (crushing)#

• Episode * !+ menit

• ii%uti sesa%, pusing, mual, atauber%eringat

8/16/2019 Ima Algoritme

12/19 

Character of potentially non-anginal pain

• Pleuritic

• .o%asinya di perut tengah atau bawah

• apat ditun/u% dengan satu /ari• apat timbul0terasa dengan pene%anan

dinding dada atau pergera%an

• .amanya hanya beberapa deti%#

8/16/2019 Ima Algoritme

13/19 

1on-anginal cause of chest pain

• &usculosceletal disorder

• 23 disorders " peptic ulcer $

• Aortic dissection• Thoracic aneurysm

• Esophageal spasm

• Pneumonia

• Pericarditis

• 1europsychiatric causes " eg# Panicdisorder $

8/16/2019 Ima Algoritme

14/19 

CC' Classi4cation

• 3 5 angina occurring with strenous butnot ordinary physical activity

• 33 5 'light limitation of ordinary physicalactivity

• 333 5 &ar%ed limitation of ordinaryphysical activity

• 36 5 3nability to carry on any physicalactivity without discomfort, symptomsmay be present at rest#

8/16/2019 Ima Algoritme

15/19 

Possible presentation of UAP

• Angina at rest, with pain episodes lasting * !+min#

• 1ew onset " within 7 ! months $ exertionalangina of at least CC'C 333

• 8ecent increase " 7 ! months $ in anginalseverity to at least CC'C 333

• Angina post &C3

8/16/2019 Ima Algoritme

16/19 

Characteristic EC2 changes in

9AP01: &3• 'T-segment depression * ; mm

• eep symmetrical T-wave

inversion in more than one pre-cordial lead#

• 1on speci4c 'T or T wave change

that resolve with resolution of pain

8/16/2019 Ima Algoritme

17/19 

Characteristic of EC2 changes in :-wave&3

• 'T elevation * ; mm in ! or morecontiguous leads

• T wave inversion• .oss of the 8 complex and appearance

of new :-wave

8/16/2019 Ima Algoritme

18/19 

8/16/2019 Ima Algoritme

19/19