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Acute Coronary Syndrome: Imelva Yulviani Girsang
Acute Coronary Syndrome: Imelva Yulviani Girsang
Acute Coronary Syndrome: Imelva Yulviani Girsang
UNSTABLE ANGINA
Features For Diagnosis
New or worsening symptoms
(angina, pulmonary edema) or signs
(ECG changes) or myocardial
ischemia.
Absence of creatinine kinase and its
MB fraction elevation, consistent with
myocardial infarction.
Physical Examination:
May be entirely normal. No physical
is spesific for unstable angina.
Transient findings for left ventricular
dysfunction (S3 and S4 gallop,
pulmonary congestion) and
arrhytmia may be present.
Patofisiologi
Angina tak-stabil terjadi karena
menurunnya perfusi ke jantung
(disrupsi plak menyebabkan
terbentuknya trombus dan
penurunan perfusi) atau peningkatan
kebutuhan oksigen (oxygen
mismatch). Trombus biasanya
bersifat labil dengan oklusi tidak
menetap. Pada angina tak stabil,
miokardium mengalami stres tetapi
Acute Coronary Syndrome
NON-ST-SEGMENT
ELEVATION MYOCARDIAL
INFARCTION (NSTEMI)
NSTEMI
The diagnosis of NSTE-ACS is based largely on the clinical
presentation. Typically, chest discomfort is severe and has at
least one of three features:
1. It occurs at rest (or with minimal exertion), lasting >10
minutes;
2. It is of relatively recent onset (i.e., within the prior 2 weeks);
3. it occurs with a crescendo pattern (i.e., distinctly more
severe, prolonged, or frequent than previous episodes).
. Antikoagulan
1. Fondaparinux : 2,5mg SC -> c/ Aristra,
2. Enoksaparin : 1mg/kg dua kali sehari) -> c/ Lovenox
. Statin
1. Dosis tinggi hendaknya dimulai
sebelum pasien keluar rumah sakit,
dengan sasaran terapi untuk
mencapai kadar kolestrol LDL
<100mg/dl (Kelas I-A)
2. Atorvastatin 10 - 20mg/hari
3. Simvastatin 10 20mg/hari