Infark Miokard

akut
Yudistira P. Santosa
 Diagnosis
• pathological diagnosis  myocyte cell
death as a consequence of prolonged
ischemia.
• Characteristic findings include coagulation necrosis
and contraction band necrosis, often with patchy
areas of myocytolysis at the periphery of the infarct.
• Acute phase of MI, the majority of myocyte loss in
the infarct zone occurs via coagulation necrosis
and proceeds to inflammation, phagocytosis of
necrotic myocytes  scar formation
 Diagnosis
• clinical diagnosis  combination the history
with some of indirect evidence of
myocardial necrosis using biochemical,
electrocardiographic, and imaging
modalities
• The sensitivity and specificity of the clinical tools for
diagnosing MI vary considerably and change at
varying times after the onset of the infarction.
Criteria for Acute, Evolving, or Recent MI
• Either of the following criteria satisfies the diagnosis
for acute, evolving, or recent MI:
1. Typical rise and/or fall of biochemical markers of
myocardial necrosis with at least one of the
following: a) Ischemic
symptoms b) Development of pathological Q
waves in the ECG c) ECG changes indicative of
ischemia (ST segment elevation or
depression) d) Imaging evidence of new loss of
viable myocardium or new regional wall motion
abnormality
2. Pathological findings of an acute myocardial
infarction
 KASUS 1
• Laki-laki, 50 tahun
• Merokok 12 batang / hari
• Kolesterol dan DM tidak diketahui
• Tidak ada tekanan darah tinggi
• Saudara pasien : meninggal krn sakit jantung

Keluhan : nyeri dada

Atrial Fibrilasi
9
 Erosion

Acute Coronary Syndrome (ACS)

Acute Coronary Syndrome (ACS)
INTIMA

ENDOTEL

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15
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TXA2

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Spektrum Klinik Sindroma Koroner
Akut
Sindroma Koroner Akut

Tanpa Elevasi Elevasi

Segmen ST Segmen ST

STEMI
NSTEMI

Angina Pektoris
Non-Q-wave Q-wave
Tidak stabil
Infark Miokard Akut
20
 ELEKTROKARDIOGRAM

Current-of-injury patterns with acute

ischemia

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 Definition of Myocardial Infarction (MI)

Criteria for Acute, Evolving, or Recent MI

Either of the following criteria satisfies the diagnosis for
acute, evolving, or recent MI:
1. Typical rise and/or fall of biochemical markers of
myocardial necrosis with at least one of the following:
a) Ischemic symptoms
b) Development of pathological Q waves in the ECG
c) ECG changes indicative of ischemia (ST segment
elevation or depression)
d) Imaging evidence of new loss of viable myocardium
or new regional wall motion abnormality
2. Pathological findings of an acute myocardial
infarction
 Clinical spectrum of haemodynamic states
in myocardial infarction and their treatment
• Right ventricular infarction: high jugular
venous pressure, poor tissue perfusion or
shock, bradycardia, hypotension.
• Pump failure: tachycardia, tachypnoea,
small pulse pressure, poor tissue perfusion,
hypoxaemia, pulmonary oedema.
• Cardiogenic shock: very poor tissue
perfusion, oliguria, severe hypotension, small
pulse pressure, tachycardia, pulmonary
oedema.
Circulation. 2004;110:588-636
Kronis