PENATALAKSANAAN AWAL

SINDROM KORONER AKUT

d r. A r f i a n A m i n N s t , M k e d ( C a r d ) , S p J P, A I F O - K
 Arterial Thrombus
Formation:
STOP THROMBOSIS PROCESS - Platelet activation
- Coagulation cascade
activation

Anti Anti
platelet koagulan
Percutaneus Coronary
Intervention (PCI)

Anti ischemic Gorog DA, et al. Arterial Thrombus

Stability. J Am Coll Cardiol.2017;70:2036-
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GENERAL APPROACH TO PATIENT WITH SUSPECTED ACS

Tubaro M, et al. Intensive and Acute Cardiovascular Care.

ESC textbook
MEDICAL TREATMENT
Aspirin : 160-320 mg (dikunyah lebih baik)
Clopidogrel : 300-600 mg atau ticagrelor (loading dose 180 mg) atau prasugrel
Nitrat sublingual :
Nitrogliserin 500 mcg atau ISDN 5 mg sublingual (dapat diulang 3x jarak 5 menit)
Nitrat IV : Nitrogliserin drip 10-200 mcg/menit titrasi atau ISDN drip IV 1-10 mg/jam
Morphine 2-4 mg IV bolus pelan
Tubaro M, et al. Intensive and Acute Cardiovascular Care. ESC
textbook
INVASIVE STRATEGY
 Myocardial
Revascularization

STEMI
NSTEMI/UAP
<12 jam

Primary PCI

Fibrinolitik
 STEMI

COMPLICATION
“TIME IS MUSCLE”
Kerusakan otot jantung semakin luas seiring waktu berjalan

Harus dilakukan reperfusi secepat mungkin, untuk menghentikan

proses infark miokard
ST Elevated Myocardial Infarction - Platelet Aggregation - Acute Coronary Syndrome - Cardiology Teaching Package - Practice
Tubaro M, et al. Intensive and Acute Cardiovascular Care.
ESC textbook
 STEMI
Primary PCI not possible → FIBRINOLITIK
Terapi Fibrinolisis :
Kontraindikasi
 OBAT FIBRINOLITIK
Streptokinase 1.5 juta IU diencerkan dalam 100 cc D5/NaCl 0.9% habis dalam
30-60 menit

Alteplase

Evaluasi: alergi, perdarahan, hipotensi, aritmia

 REPERFUSION
STRATEGY

STEMI NSTEMI/UAP

Stratifikasi
Risiko

Invasif segera Invasif dini Invasif

Non Invasif
<2 jam <24 jam <72 jam
Step by Step ACS Management
TERIMA KASIH