stemi extensive anterior wall onset 5 hours killip fix
Post on 22-Feb-2018
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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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American *eart Association5 /ttp5!!atc/learnli+e'/eart'org
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American *eart Association5 /ttp5!!atc/learnli+e'/eart'org
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American *eart Association5 /ttp5!!atc/learnli+e'/eart'org
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American *eart Association5 /ttp5!!atc/learnli+e'/eart'org
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American *eart Association5 /ttp5!!atc/learnli+e'/eart'org
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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
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