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    Nstemi + Af RVR

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    Fitrianto Dwi Utomo
    This case report describes a 73-year-old male patient admitted to the hospital with chest pain. Physical examination and tests revealed the patient had atrial fibrillation with a rapid ventricular response, lateral non-ST-elevation myocardial infarction, and triple vessel coronary artery disease including a chronic total occlusion in one vessel. The patient underwent angiography that showed significant blockages and was started on medications while also needing risk factor control and potential future CABG surgery. His prognosis was noted to be questionable due to potential future life threatening events from his conditions.

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    Nstemi + Af RVR

    Uploaded by

    Fitrianto Dwi Utomo
    141 views16 pages
    This case report describes a 73-year-old male patient admitted to the hospital with chest pain. Physical examination and tests revealed the patient had atrial fibrillation with a rapid ventricular response, lateral non-ST-elevation myocardial infarction, and triple vessel coronary artery disease including a chronic total occlusion in one vessel. The patient underwent angiography that showed significant blockages and was started on medications while also needing risk factor control and potential future CABG surgery. His prognosis was noted to be questionable due to potential future life threatening events from his conditions.

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    NSTEMI + AF RVR

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    This case report describes a 73-year-old male patient admitted to the hospital with chest pain. Physical examination and tests revealed the patient had atrial fibrillation with a rapid ventricular response, lateral non-ST-elevation myocardial infarction, and triple vessel coronary artery disease including a chronic total occlusion in one vessel. The patient underwent angiography that showed significant blockages and was started on medications while also needing risk factor control and potential future CABG surgery. His prognosis was noted to be questionable due to potential future life threatening events from his conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    141 views16 pages

    Nstemi + Af RVR

    Uploaded by

    Fitrianto Dwi Utomo
    This case report describes a 73-year-old male patient admitted to the hospital with chest pain. Physical examination and tests revealed the patient had atrial fibrillation with a rapid ventricular response, lateral non-ST-elevation myocardial infarction, and triple vessel coronary artery disease including a chronic total occlusion in one vessel. The patient underwent angiography that showed significant blockages and was started on medications while also needing risk factor control and potential future CABG surgery. His prognosis was noted to be questionable due to potential future life threatening events from his conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 16

    Lateral Non ST-Elevation Myocardial

    Infarction with Atrial Fibrilation


    Rapid Ventricular Response

    CASE REPORT
    CARDIOLOGY DEPARTMENT
    Faculty of Medicine, Tanjungpura University
    Supervisor : Prihati Pujowaskito, dr., Sp.JP(K), MMRS
    By : Elok Nur Farida Anggraini, S.Ked

    Dustira Hospital, Cimahi


    PATIENT IDENTITY
    Name : AM
    Sex : Male
    Age : 73 years old
    Address : West Bandung
    Occupation : Indonesian Army (Retired)
    Admission date : October 2nd, 2017
    CHIEF COMPLAINT
    Chest pain
    HISTORY OF PRESENT ILLNESS
    Chest pain that described as a "pressure" and
    discomfort in the chest especially on the left side
    Since 9 hours before admission to ER
    The pain radiates to his left shoulder
    The pain duration is about 20 minutes
    The complaint is sometimes accompanied by cold
    sweating, nausea, and shortness of breath
    HISTORY OF PAST ILLNESS
    Hypertension (+)
    Diabetes Mellitus (+)
    Hypercholesterolemia (+)
    Tobacco use (+)

    Family history of Coronary Artery Disease (-)


    PHYSICAL EXAMINATION
    Compos Mentis Head : Normocephal
    Eye, Ear, Nose, Throat, and Neck
    SpO2 : 98%

    Eye : Conjunctiva anemic (-), sclera icteric (-)


    Vital Sign Ear : Normotia/normotia, secret -/-
    BP : 150/100 Nose : Cavum nasi clear/clear, secret -/-
    mmHg Throat : Pharynx hyperemic (-)
    HR : 110 x/min, Neck : JVP normal, lymph node swelling (-)
    iregular, pulsus Pulmo : Vesicular (+/+), wheezing (-/-), rhonki (-/-)
    deficits (+) Cor : Regular S1/S2, murmur (-), gallop (-)
    RR : 24 x/min Abdomen : Bowel sounds (+), soepel, tenderness (-)
    Extermities : edema (-/-), CRT <2s
    T : 36,7 C

    LABORATORY FINDINGS
    HGB : 14,4 g/dL Random glucose level :
    RBC : 5,1 x 106 /L 124 mg/dL
    WBC : 12.600 /L Creatinine: 1,0 mg/dL
    HCT : 41,9 %
    PLT : 263.000 /L
    MCV : 82,0 fL
    CK-MB : 67 U/L
    MCH : 28,2 Pq Troponin I : -
    MCHC : 34,4 g/dL
    RDW : 13,8 % HbsAg : Non reactive
    Ba/Eo/Sg/Li/Mo :
    0,6/1,1/72,0/19,6/6,7 %
    ELECTROCARDIOGRAM

    Interpretation
    HR : 160 bpm
    Rhythm : Atrial Fibrillation
    Axis : Left Axis Deviation
    QRS complexes : 97 ms
    qR complexes : lead I, aVL
    rS complexes : lead II, III, aVF
    ST segment : ST-depresion
    lead I, aVL, V5-6

    Conclusion
    Lateral NSTEMI
    Atrial Fibrillation RVR
    Left Anterior Fascicular Block
    ANGIOGRAPHY

    LM : Stenosis 40% in Distal


    LAD : Stenosis 80-90% in
    Proximal, stenosis 70-80% in Mid
    LCx : CTO (Chronic Total
    Occlusion) in Proximal
    RCA : Stenosis 70-80% in Mid

    Coronary Artery Disease (triple


    vessel disease) + CTO
    ECHOCARDIOGRAM
    Left Ventricular dilatation
    Left Ventricular Hypertrophy
    Hypokinetic anterolateral
    Normo valves
    Left Ventricular systolic dysfunction
    Left Ventricular normo diastolic function
    Right Ventricular systolic function
    Thrombus (-)
    Ejection Fraction 52%
    INITIAL DIAGNOSIS
    Clinical diagnosis :
    NSTEMI Acute Coronary Syndrome +
    Atrial Fibrillation RVR
    Anatomical diagnosis :
    Lateral Myocardial Infaction with stenosis 40% in distal
    LM, stenosis 80-90% in proximal and 70-80% in mid
    LAD, stenosis 70-80% in mid RCA, and CTO in proximal
    LCx
    Etiological diagnosis :
    Atherosclerotic disease in LM, LCx, LAD and RCA
    MANAGEMENT

    Inj. Amiodaron 300 mg diluted in Risk factor control


    250 mL 5% dextrose over 30-60 Bleeding evaluation
    minutes
    Pro CABG
    Dabigatran Etexilate 2 x 110 mg
    Clopidogrel 1 x 75 mg
    Acetylsalicylic acid 1 x 100 mg
    Isosorbid dinitrate 3 x 5 mg
    Valsartan 1 x 80 mg
    Bisoprolol 1 x 5 mg
    Rosuvastatin 1 x 20 mg
    Metformin 3 x 500 mg
    PROGNOSIS
    Quo ad vitam : dubia ad malam
    Quo ad functionam : dubia ad malam
    Quo ad sanactionam : dubia ad malam
    THANK YOU

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