MYOCARDIAL

INFARCTION
 When coronary blood flow is interrupted for an extended period,
Definisi myocyte necrosis occurs. This results in MI.
Coronary  atherosclerotic CAD

Blood Flow  coronary spasm and

 coronary artery embolism.
Alteration
  Pathologically : subendocardial infarction and transmural
Classification infarction.
 Clinically : non-STEMI or STEMI.
Pathophysiology
  Mampu bertahan melawan kondisi ischemic selama 20 menit
 Penurunan suplai oksigen  Anaerobic  Glikogen Stores turun
 akumulasi ion hydrogen dan asam laktat
 Acidosis
 Gangguan Elektrolit
 Penurunan ATP
Celullar Injury  Peningkatan Intracelullar Calsium  Activate Lipase dan Protease
 Release of Cathecolamine  Harmful detergent effect,
peningkatan gula darah, irregular heartbeats.
 Reperfusion injury  opening mPTP  cellular death
 Angiotensin II  vasocontriction and water retention and
Promotes cathecolamine release and Coronary Artery Spasm
  Necrosis  pengeluaran intracellular enzyme  Dibawa sama
Celullar Death lymphatic system  blood stream  terlihat diuji serologic
  Myocardial Stunning
Structural and  Hibernating Myocardium
Functional  Myocardial Remodelling
Changes
  Sudden severe chest pain, rasanya berat dan ada yg menekan.
Radiation neck, jaw, back, shoulder, or left arm
 Silent infarct pada beberapa individu
 Nausea and vomit
Manifestasi  Peningkatan HR dan BP. Severe myocard damage  Hypotension
Klinis  Vasocontriction  cold and clammy skin
 Cardiac murmur
 Pulmonary congestion
 Abnormal Extra Heart Sound
  Dysrhytmia
 Functional impairment
 Cardiogenic shock
 Pericarditis
 Dressler post infarction syndrome
Complication  Organic brain syndrome
 Rupture heart structure
 Thromboembolism
 Pulmonary embolism
  Diagnosis based on : HT, PE, ECG, and Biomarker
 Biomarker Troponin I, CPK+MB and LDH, Leukocytes and CRP
 Blood Glucose and Glucose Tolerance
 Morphine sulfate buat atasi Pain
 Monitoring cardiac biomarker dan cardiac dysrhythmia
Evaluation and  Non STEMI  antithrombotic, anticoagulant/PCI

Treatment  STEMI  antithrombolytic + PCI

 Hyperglicemia  Insulin
 Shock  resusitasi dan ionotropic drugs
 Bedrest
 Edukasi bagi orang-orang dengan factor resiko yang tinggi.