Adaptive Restore algorithm & importance Monte Carlo
Case Report STEMI English with total AV Block.pptx
1. Thursday, April 25th 2024
Team on Duty:
ICCU:
dr. Wahyu Ekawati/ dr. Dinda Feraliana
Ward:
dr. Ryzka Izza Mayfany / dr. Muhammad Aulia
IGD Existing :
dr. Eri Mizwar / dr. Ridia Alvi Fitria / dr. Hendra Pranata
Supervisor on duty in RSUZA Existing:
dr. Sri Murdiati, Sp.JP - FIHA
3. • Name : Ramli AR
• Gender : Male
• Age : 75 y.o
• Race/ethnicity : Aceh
• Marrital status : Married
• Religion : Islam
• No. CM : 1-36-82-14
4. Chief complaint : Chest pain
The patient was reffered from Bireun Hospital to the emergency department with a chief complaint of chest pain that had been felt since
5 days before admission. Chest pain felt as a heavy sensation on the left chest that didn't reduced at rest. Chest pain was radiated to the
back, neck and left arm. Chest pain happened for more than 20 minutes. Chest pain was accompanied with diaphoresis, but nausea and
vomiting were denied. Patient admit that he never felt like this before. Chest pain was accompanied with shortness of breath, which is
worsened if the patient lying down. Leg swelling were denied. Cough and fever were denied
History of Past Illness :
• Hypertension for more year 10 years (patient didn’t consume antihypertension regularly)
• Diabetes Melitus were denied
• Stroke were denied
• Familial history of heart disease was denied
Habitual History: Patient was an ex-smoker for > 20years, he stopped smoking in 2011. He used to smoke 2-3 packs of cigarettes per
day
History of Medication :
SC Fondaparinux 2,5 mg/24 hours (Day 3)
IV Lansoprazole 30 mg/12 hours IV Morfin 2 mg (if needed only) IV Sulfa Atropine 1 mg (extra)
Aspilet 80 mg o.d Atorvastatin 40 mg o.d Alprazolam 0,25 mg o.d.
Clopidogrel 75 mg o.d ISDN 5 mg sublingual
7. ECG of Ramli, 75 y.o, from RSUD Bireun
(2 days onset)
• Conclusion: Total AV Block, QRS rate 45 bpm, normoaxis, ST elevation at lead II, III, avF
ECG interpretation:
Calibration : 10 mm/mV
Rhythm : TAVB
Heart Rate : 45 bpm
Axis : normoaxis
P wave : 80 ms
PR interval : 240 ms
QRS complex : 80 ms
ST segment : ST elevation at lead II, III, avF
Q Patologis : none
8. ECG of Ramli, 75y.o, CM 1-36-82-14
at RSUDZA when arrive at ER (25/4/2024)
ECG interpretation:
Calibration : 10 mm/mV
Rhythm : TAVB
Heart Rate : 47 bpm
Axis : normoaxis
P wave : 80 ms
PR interval : 240 ms
QRS complex : 80 ms
ST segment : ST elevation at lead II, III, avF
Q Patologis : none
• Conclusion: Total AV Block, QRS rate 47 bpm, normoaxis, ST elevation at lead II, III, avF
9. Working diagnose
1. Recent STEMI interior 5 days onset KILLIP II without
revascularization
2. Acute Heart Failure on ACS
3. Total AV Block
14. 1. Recent STEMI interior 5 days onset KILLIP II without
revascuralization TIMI 8/14 GS 152
2. Acute Heart Failure on ACS
3. Total AV Block
Working diagnose
