Acute Coronary Syndrome

(Sindroma Koroner Akut)

Zulfikri Mukhtar
Kapan Atherosklerosis Terja
Atherosklerosis
Berawal dari usia
balita sampai dengan
lansia

Tedjasukmana P
 FAKTOR RESIKO PJK

TIDAK DAPAT DI DAPAT DI

INTERVENSI INTERVENSI
Usia > 40 thn (lk) MEROKOK
Pr : Menopause HIPERTENSI
Jenis kelamin DIABETES
Riwayat Keluarga HIPERKOLESTEROL
PJK : Penyakit Jantung Koroner
PLAK ATEROsklerOSIS
Adalah deposit dari :
 KOLESTEROL (UTAMA)
 KALSIUM
 JARINGAN IKAT
 OTOT POLOS
 KOMPONEN DARAH
 FIBRIN
 KARBOHIDRAT
Coronary Heart Disease :

1.Stable Angina Pectoris

2.Unstable Angina Pectoris
3.Non-ST Segment Elevation Myocardial
Infarction
4.ST Segment Elevation
Myocardial Infarction
5.Suddent Cardiac Death
Acute Coronary Syndrome
Dimana Rasa Nyeri Dirasakan??
 Acute Myocardial infarction
WHO :
1.Clinical symptom : angina pain > 20 minutes
(typical infarct pain).
2. ECG changes (ST-T changes or new LBBB).
3. Laboratorium : increase cardiac enzyme
(SGOT, LDH, CPK – standard – 4 h from onset)
CKMB, Troponin T (1 h from onset) ( 2 of 3
criteria).
 Unstable Angina Pectoris

Diagnosis :
1.Typical angina > 20 minutes
2.Finds ECG changes ( ST segment depression
or T wave inversion)
3.No increase cardiac enzyme
 NSTEMI
(non ST segment elevation myocardial infarction –
Non Q wave infarction )

1. Typical angina pain > 20 minutes

2. ST-T changes (ST segment depression or T
wave inversion)
3. Elevated cardiac enzyme
 STEMI
(ST segment elevation myocardial infarction)

1. Typical angina pain > 20 minutes

2. ECG changes : ST segment elevation.
3. Increase cardiac enzyme
 STEMI

1. Inferior wall ( limb lead ;lead II, III, aVF 

2 of 3 ) ST elevation : 1 mV.

2. Anterior wall ( Precordial lead; V1 – V6 )

ST elevation : minimal 2 mV.
ST Elevation Myocardial Infarction
 Spectrum ACS
Acute coronary syndrome

No ST elevation ST elevation

No enzyme enzyme
Rise rise

UAP NQ- MI Qw MI
NSTEMI
 Management ACS

Emergency ward.
1.Oxygen 2 – 3 l /m
2.IV line
3.Nitrate 5 mg sublingual.
4.Killing pain : Morphin 2,5 – 5 mg (Dilute, IV,
if HR > 90 x / m. Pethidine 25 – 50 mg (Dilute,
IV, if HR < 90 x /m).
 Management ACS
Emergency ward.
5. Clopidogrel (75 mg/tab) : 600 mg (onset 2
hours) ; 300 mg (onset 4 hours), 75 mg/d
Aspirin : 300 mg (enteric coated- chewed)
80 , 100 , 0r 160 mg /d
Anticoagulant :
-UFH (unfractionated heparin) : bolus
5000 units, maintenance 750 – 1000 U/h
Controle :aPTT 2 – 3 normal.
 Management ACS
Emergency ward.
5. - LMWH.
=Enoxaparine or dalteparine ( Porcine) 100 U/
kg, twice daily or 60 mg / 12 h)
=Fondafarinux (synthetic) 2,5 mg /d

-> care in ICCU / ICU ward.

 Management ACS
ICCU / ICU ward.
5. Nitrate intravenous
- ISDN (isosorbide dinitrate ) 1-2 mg /h
(syringe pump 10 mg or 1amp/50 cc)
- Nitroglycrine : 10 – 200 micro U/ m
(Nitrocine 10 mg / 50 cc-syringe pump)
 Management ACS
ICCU / ICU ward.
5. Statin (all statin).
If necessary ( heart failure  diuretic).
Anterior wall infarct ( beta blocker , ACE
inhibitor).
Thrombolytic ( if STEMI anterior wall ,
onset symptom< 12 hours)
1.
 Primary Angioplasty (PCI)
The current gold standard reperfusion of
STEMI
STEMI onset of symptom < 12 h, more benefit
< 6 hours.
The necessary backup : Suction thrombus,
TPM, IABP.
Drug : Gp II b / IIIa.
Open : infarct related artery only.