Introduction: The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as static pattern associated with anterior myocardial infarction. A recent study showed the evolution sequence of this pattern into typical ST-elevation myocardial infarction (STEMI). This case discussed dWP who present as pre-anterior STEMI.
Case Illustration: A-56-year old Male arrived in the emergency room complained chest pain about 3 hours. The patient also complained of diaphoresis, nausea, and fatigue. The patient has a previous history of hypertension. The vital signs were stable with an unremarkable physical examination. The initial electrocardiogram (ECG) revealed sinus rhythm with j-point depression followed by prominent T wave in precordial leads, slight ST-segment elevation in aVR, and loss of precordial R-wave progression. The initial-troponin-T was 31 pg/mL. Follow-up 1-hour after initial ECG showed typical ST-segment-elevation in V1-V4. The patient undergoing thrombolytic, followed by angiography that showed subtotal occlusion in the proximal left anterior descending (LAD) artery, occlusion in the proximal circumflex artery and stenosis in proximal right coronary artery, echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was discharged after 8-days treated in intensive cardiac care unit.
Conclusion: dWP has been shown as static and dynamic pattern in some conditions and associated with acute LAD occlusion. In this case, we showed dWP as early anterior STEMI, recognition of this pattern lead to early reperfusion and better myocardial salvage as anterior STEMI has a poor outcome.
Penyakit jantung koroner (PJK) merupakan salah satu penyakit jantung yang paling ditakuti, hal ini dikarenakan penyakit ini dapat menyebabkan mendadak. Penyakit ini disebabkan oleh adanya sumbatan atau penyempitan pada arteri koroner, sehingga aliran darah ke sel otot dan jaringan sekitar jantung menjadi terganggu. Yang berperan dalam terbentuknya sumbatan ini ialah LDL. Secara teori, akumulasi LDL akan memicu terjadinya penimbunan lemak yang menyebabkan aterosklerosis. Tujuan dilakukan penelitian ini ialah untuk mengetahui apakah kadar LDL berpengaruh dengan kejadian Sindrom Koroner Akut. Penelitian ini menggunakan desain penelitian observasional analitik dengan pendekatan cross-sectional dengan sumber data sekunder dari RSUD Abdul Wahab Sjahranie Samarinda, yang melibatkan 103 sampel yang sesuai dengan kriteria inklusi dan 6 sampel yang sesuai dengan kriteria eksklusi. Analisis dilakukan dengan menggunakan uji statistik Chi-square. Analisa ini bertujuan untuk mengetahui hubungan antara kadar LDL dengan kejadian SKA. Terdapat 34 pasien memiliki kadar LDL yang optimal (33,0%), sedangkan sebanyak 69 pasien memiliki kadar LDL tidak optimal (67,0%). Pada analisis bivariat didapatkan p value = 0,030 yang dapat disimpulkan bahwa terdapat hubungan antara kadar LDL dengan kejadian SKA.
Patients with Acute Myocardial Infarction with ST Segment Elevation (STEMI) should be given reperfusion therapy with fibrinolytic or PPCI (Primary Percutaneous Coronary Intervention) to prevent further myocardial damage. Currently PPCI is the main therapy choice for STEMI patients, but not all health facilities have these facilities. Thus, fibrinolytic may be the reperfusion therapy of choice in patients STEMI with chest pain onset ? 12 hours and without contraindications. STEMI can affect heart function, so the LVEF (Left Ventricular Ejection Fraction) value can be used to assess heart systolic function which can affect the prognosis of STEMI patients. The aim of this study was to identify the difference of LVEF values ??between STEMI patients undergoing reperfusion therapy with fibrinolytic and PPCI at Abdul Wahab Sajahranie Hospital, Samarinda. This study was an analytic observational study with a cross sectional design. The study population was all STEMI patients who undergoing reperfusion therapy with fibrinolytic and PPCI at Abdul Wahab Sjahranie Hospital, Samarinda for the period 2018-2019. Sampling was purposive sampling, with data sources derived from the patient's medical records. LVEF values ??were examined using transthoracic echocardiography, and Independent T-Test was used to analyze the difference of LVEF values ??between these groups. The result showed there was no significant difference in the LVEF value of STEMI patients undergoing reperfusion therapy with Fibrinolytics and PPCI (fibrinolytic 51.37 ± 12.254%, PPCI 56.47 ± 11.98%; p = 0.103 (p> 0.05)).
Keywords: STEMI, Fibrinolytic, PPCI, LVEF
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