STEMI Extensive Anterior Wall Onset 5 Hours KILLIP Fix

7/24/2019 STEMI Extensive Anterior Wall Onset 5 Hours KILLIP Fix

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Pa$i%n$ Id%n$i$&

Na'% ( Mr)* RA

A+% ( "! &%ar) ,ld

R%+i)$%r n,* ( -!".8/Da$% , ad'i))i,n ( S%$2 !.$h!01"


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Hi)$,r& Ta3in+

Chi% 4,'lain$ ( #hest pain

Hi)$,r& $a3in+ (

I$ ha) 5%%n %l$ / h,6r) 5%,r% ad'i$$%d $, $h%

h,)i$al* Pain %l$ li3% r%)) and 56rn ,n hi) l%$4h%)$2 %n%$ra$%d $, $h% 5a43 5,d&* Sh% $,ld $ha$)h% had l,7 5a43 ain " da&) a+,*

F%%r :;2 Ei+a)$ri4 ain :;2 C,6+h :;2 ,'i$in+


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Pa)$ Illn%)) Hi)$,r&

Hi)$,r& , h&%r$%n)i,n :;

Hi)$,r& , Dia5%$%) '%lli$6) :;

Fa'il& hi)$,r& , h%ar$ di)%a)%


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Ri)3 Fa4$,r

MODIFIA>LE (


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Ph&)i4al E?a'ina$i,n

$eneral Appearan%e ( M,d%ra$%:illn%))@n,r'al >@4,n)4i,6)

&ital Sin : >l,,d Pr%))6r% ( 1!0@80 ''H+ P6l)% ( 9! 5'2 r%+6lar R%)ira$,r& ra$% ( !/ $' B $h,ra4,a5d,'inal T%'%ra$6r% ( .2- C %r a?illa;

'ead Exa!ination : E&%) ( an%'ia:;2 i4$%r6) :;2 4&an,)i) :; N%43 ( VP R


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Thora%i% Exa!ination : In)%4$i,n ( S&''%$ri4 l%$

and ri+h$ Pala$i,n ( N, 'a))2 n,

$%nd%rn%)) P%r46))i,n ( S,n,r A6)46l$a$i,n ( >r%a$h S,6nd (

%)i46lar2 Rh :@:2 h :@:


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#ardia% Exa!ination :

In)%4$i,n ( I4$6) C,rdi) n,$ i)i5l% Pala$i,n ( I4$6) C,rdi) n,$ala5l%

P%r46))i,n ( P%4a4


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Abdo!inal Exa!ination : In)%4$i,n ( Fla$ and ,ll,7in+

5r%a$h ',%'%n$

Pala$i,n ( N, 'a))2 n, $%nd%rn%))2li%r and )l%%n 6nala5l% P%r46))i,n ( T&'ani A6)46l$a$i,n ( P%ri)$al$i4 ),6nd


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Radi,l,+& Findin+

C,n4l6)i,n (Cardi,'%+al& 7i$h

dila$a$i,na,r$a%


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EC# In$%rr%$a$i,n

()thSepte!ber (*+5

Rh&$h'( Sin6) rh&$h'

P 7a% ( 020/ )

H%ar$ Ra$% ( 10 5'2 Irr%+6l%rPR in$%ral ( 021! )

D6ra$i,n RS ( 021! )

K,n+6ra$i,n ( 7a% V1:V.

A?i) ( N,r',a?i)ST S%+'%n$ ( ST:El%a)i ada L%ad V!2 V2 V/2

V"2 aVL

#on%lusion : STEMI Extensive anterior Wall


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La5,ra$,r& Findin+)

() thsepte!ber (*+5

C,'l%$% 5l,,d 4,6n$

>C ( 92. ? 10@6l

H#> ( 121 +r@dl HCT ( 829 J

PLT ( 1!! ? 10@6l

En&'% #K : +,, !!ol-l

CK:M> ( !12. '',l@l

Troponin I : */5

!!ol-l

>l,,d 4h%'i)$r&

Ur%6' ( !" '+@dl

Cr%a$inin% ( 02-9 '+@dl

S#OT@S#PT ( !/@1/ 6@dl

#hol. Total : (**!-dl

HDL ( 8. '+@dl

LDL ( 11 '+@dl

T#( -1 '+@dl #DS ( 1"9 '+@dl

Uri4 a4id( /2! '+@dl


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E4h,4ardi,+rah&

S&)$,li4 6n4$i,n , LV 7a) d%4r%a)%d2 EF/9J

H&,3in%$i4 )%+'%n$al

Dia)$,li4 d&)6n4$i,n LV +rad% II


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,r3in+ Dia+n,)i)

STEMI Extensive AnteriorWall onset 5 hours KILLIP I


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Mana+%'%n$Bed rest

Oxygen 2-4 lpm via nasal canule

IVFD NaCl 0.! "00 cc#24 $%urs

Nitr%gliserin

Farsorbid 10mg sublingual (if VAS >3)&ntiplatelet

Loading aspilet 160 mg , maintenance 0 mg!"# $am

Loading clopidogrel 300 mg , maintance %& mg!"# $am

'$r%m(%liticStreptase 1'&00'000

*eparin bolus #'000 , maintenance %00 iu'$am!+iasrnge pump

&ntidislipidemia


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S2SS4

ST ELE&ATI01 M20#A34IALI1A3#TI01


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4EI1ITI01

A46$% '&,4ardial inar4$i,n AMI; i) anirr%%r)i5l% n%4r,)i) , h%ar$ '6)4l% d6% $,r,l,n+%d i)4h%'ia2 7hi4h i) )6dd%nl&

ha%n%d*I'5alan4% in ,?&+%n )6l& and d%'and2

7hi4h i) ',)$ ,$%n 4a6)%d 5& la6%r6$6r% 7i$h $hr,'56) ,r'a$i,n in a

4,r,nar& %))%l2 r%)6l$in+ in an a46$%r%d64$i,n , 5l,,d )6l& $, a ,r$i,n , $h%'&,4ardi6'*


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PAT'0P'2SI0L0$2

O446r) 7h%n 4,r,nar& 5l,,d,7 d%4r%a)%) a5r6$l& a$%ra $hr,'5,$i4 ,44l6)i,n , a4,r,nar& ar$%r& r%i,6)l&

aG%4$%d 5& a$h%r,)4l%r,)i)*

In ',)$ 4a)%)2 inar4$i,n,446r) 7h%n an

a$h%r,)4l%r,$i4 la6%))6r%)2 r6$6r%)2 ,r6l4%ra$%)


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American *eart Association5 /ttp5!!atc/learnli+e'/eart'org

PAT'0P'2SI0L0$2


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*ender and &ge

7en, increased ris8 > age #&

9omen, increased ris8 > age &&

Family +ist%ry

2A diagnosed before age && in

fat/er or brot/er

2A disease diagnosed before

age 6& in mot/er or sister

N%n-,%diia(le ,%diia(le Smo8ing

*pertension

iabetes7ellitus

slipidemia

besit

Lac8 of p/sical

acti+it

I/ F&C'O/


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C+&N*1/ IN 1C*


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DI&*NO/I/


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I))I C)&//IFIC&'ION

2lass escription 7ortalit :ate (;)

no clinical signs of /eart failure 6

rales or crac8les in t/e lungs, an

S3, and ele+ated $ugular +enouspressure

1%

acute pulmonar edema 30 - #0

V cardiogenic s/oc8 or/potension (sstolic


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T'A1K 206

STEMI Extensive Anterior Wall Onset 5 Hours KILLIP Fix

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