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STEMI Extensive Anterior onset < 6 hours Killip 1

STEMI Whole Anterior ONSET >12 HOURS KILLIP II

By: Kristina SabariSupervisor:Prof. dr. Peter Kabo, PhD, Sp.FK, Sp.JP(K),FIHA,FAsCCCase ReportApril 2015Medical Faculty of Hasanuddin University, Makassar 2015

Name : Mr. B Gender : Male Age : 46 years old Registration no. : 708726Date of admission : April 16th2015 Room : CVCUPatients IdentityHistory TakingChief Complaint:Chest pain

History of Present Illness:Left chest pain felt since one day prior to admission.Described as compressed pain and radiating to left arm, intermittently, duration of pain : > 20 minutes associated with shortness of breath and cold sweating dyspnea, nausea and vomiting were present

History of Past IllnessPast Illness History :History of smoking, 1 packs per day since youngHistory of chest pain on left chest about 1 year agoNo history of hypertensionNo history of Diabetes MellitusNo history alcohol consumptionNo family history of heart disease

Risk Factors Modified Risk Factor:-Smoking-Lack of activity

Non-modified Risk Factor:-Gender: Male-Age : 46 years oldGeneral StatusModerate illness / Normal / ConsciousWeight: 60 kgHeight: 165 cmBMI: 22,00 kg/m2Vital StatusBlood pressure :100/70 mmHgHeart rate: 88 bpmRespiratory rate : 20 rpmTemperature: 36,7 oC

PHYSICAL EXAMINATIONHead: Anemic (-), icterus (-), cyanosis (-)Neck: Lymphadenopathy (-), JVP R+2 cmH2OThorax:Inspection: Symmetrical left=rightPalpation : Mass (-), tenderness (-), normal vocal fremitusPercussion: SonorAuscultation : Bronchovesicular, basal ronchi +/+, wheezing -/-

ContHeart :Inspection: ictus cordis not visiblePalpation: ictus cordis not palpable, thrill (-)Percussion: DullUpper border 2nd ICS sinistraRight border 4th ICS linea parasternalis dextraLeft border 5th ICS linea axillaris anterior sinistraAuscultation: heart sound I/II pure, regular, murmur (-)

ContAbdomen :Inspection : flat and follows breath movementAuscultation: Peristaltic sound (+), normalPalpation: Liver and spleen unpalpablePercussion: Tympani (+), ascites (-)

Extremities :Edema (-)

ContLABORATORY FINDINGSTESTRESULTNORMAL VALUEWBC22,6x 103/uL4.0 10.0 x 103RBC5,09 x 106/uL4.0 6.0 x 106HGB15,0 g/dL12 18 HCT45,0%37 48 PLT388 x 103/uL150 400 x 103PT9,810 - 14APTT30,722,0 - 30,0TESTRESULTNORMAL VALUEGlucose103 mg/dL 67kg1Anterior MI or LBBB1Delay treatment >4hours1 Total Score Risk of Death in 30 days00.8%11.6%22.2%34.4%47.3%512.4%616.1%723.4%826.8%9-1435.9%Acute coronary syndrome, 3rd ed.Revised and expanded

KILLIP CLASSIFICATION

ClassDescriptionMortality Rate (%)Ino clinical signs of heart failure6IIrales or crackles in the lungs, an S3, and elevated jugular venous pressure17IIIacute pulmonary edema30 - 40IVcardiogenic shock or hypotension (systolic BP < 90 mmHg), and evidence of peripheral vasoconstriction60 80Acute coronary syndrome, 3rd ed.Revised and expandedTHANK YOU