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Cardiovascular dysfunction is a disorder of the blood vessels, such as hypertension, heart failure, and stroke. In 2016, cardiovascular disease was the leading cause of death worldwide, based on data from the World Health Organization (WHO). Coronary Heart Disease (CHD) is the leading cause of death, along with stroke, as shown by the Sample Registration System survey in 2014.This case involves a 64-year-old male, Mr. N, who presented to the emergency department of RSUD dr. Fauziah Bireuen with complaints of chest pain that developed gradually and worsened over the past month. The pain was located across the entire chest and radiated to the back and neck. The pain was described as severe, like being crushed by a heavy load, worsened during strenuous activities such as cutting grass and chopping wood, and relieved when the patient bent forward. The pain could occur at any time, with a Visual Analog Scale (VAS) score of 10 (severe pain). The patient also reported easy fatigue during heavy physical activity over the past month. Laboratory examination revealed elevated leukocytes, mean corpuscular volume (MCV), segmented neutrophils, troponin I, cholesterol, and triglycerides. The patient was diagnosed with extensive anterior ST-elevation myocardial infarction (STEMI) post successful fibrinolytic therapy.

Hypertension is a major modifiable risk factor contributing to the development of Acute Coronary Syndrome (ACS), which includes STEMI, NSTEMI, and unstable angina. The increasing prevalence of hypertension worldwide raises concern regarding its impact on cardiovascular outcomes. This study aimed to describe the profile of ACS patients with hypertension receiving angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) therapy in the Intensive Coronary Care Unit (ICCU) of RSUD Dr. Soetomo Surabaya. Using a descriptive cross-sectional method, data from 91 patients treated between July 2021 and October 2024 were analyzed. Variables included demographic characteristics, clinical classification of ACS, hypertension degree, comorbidities, types and doses of ACEI/ARB administered. The results showed that most patients were male (73%) and aged over 65 years (40%). Chi-square analysis revealed no significant relationship between hypertension degree, ACS classification, or most comorbidities with drug selection or dosage (p>0.05), except for a significant association between coronary heart disease comorbidity and ARB selection. These findings suggest that in hypertensive ACS patients, the choice between ACEI and ARB therapy is predominantly based on individual comorbidity profiles rather than blood pressure severity or ACS type. The study highlights the importance of personalized treatment approaches considering patient comorbidities to optimize cardiovascular outcomes.

A 64-year-old male patient presented to the emergency department (ED) of RS Cut Meutia with complaints of left-sided chest pain radiating to both arms, which had been occurring for two days prior to his hospital admission. The chest pain was described as sharp, sudden, and progressively worsening, and it persisted without relief from positional changes. The pain intensity was rated as 9/10 and was accompanied by cold sweats and nausea. The patient had a history of type 2 diabetes mellitus for 15 years and had been on antidiabetic medications, although he could not recall the names of the medications. The patient was a smoker but had quit smoking upon being diagnosed with diabetes. Vital signs and general status were within normal limits upon examination. Local examination of the heart revealed a murmur on auscultation. Laboratory results showed anemia, leukocytosis, hyperglycemia, and hypercholesterolemia. Electrocardiography (EKG) indicated signs of inferior STEMI (ST-Elevation Myocardial Infarction). The patient was treated with furosemide 1 amp/12 hours, atorvastatin 1x20 mg, arixtra 1x0.25 mg, aspilet 1x8 mg, clopidogrel 1x75 mg, nitrokaf retard 2x2.5 mg, and bisoprolol 1x2 mg, along with non-pharmacological management, including three-way catheter insertion and oxygen therapy at 2-4 liters per minute. Acute Coronary Syndrome (ACS) carries a poor prognosis if not managed promptly and correctly. Understanding the appropriate management of ACS is crucial in preventing further myocardial occlusion and improving patient outcomes. Therefore, rapid and accurate intervention is vital in improving the prognosis for patients with ACS.

ST-Elevation Myocardial Infarction (STEMI) is one of the manifestations of acute coronary syndrome (ACS) and is a leading cause of disability and death worldwide. The mortality rate for STEMI is reported to reach 6%–14% of all ACS deaths. Reperfusion therapy is the primary treatment, with fibrinolytics an important option, especially in healthcare facilities that do not have the capacity to perform primary Percutaneous Coronary Intervention (PCI) in less than 12 hours. The success of fibrinolytics is influenced by various risk factors, such as hypertension, dyslipidemia, diabetes mellitus, a history of heart disease, and the duration of the attack. This study aims to determine the relationship between these factors and the success rate of fibrinolytics in STEMI patients. This study used a retrospective descriptive design with a cross-sectional method. The sampling technique used total sampling of patients diagnosed with STEMI and receiving fibrinolytic therapy according to inclusion and exclusion criteria at Dr. Fauziah Hospital. Statistical analysis was performed using the Chi-Square correlation test to assess the relationship between clinical variables and fibrinolytic success. The results showed no significant association between hyperglycemia (p = 0.823), hypertension (p = 0.240), or a history of heart disease (p = 0.704) and fibrinolytic success. Similarly, the onset of stroke variable did not show a significant association with reperfusion outcomes. In conclusion, classic risk factors such as hyperglycemia, hypertension, and a history of heart disease were not associated with fibrinolytic success in STEMI patients at Dr. Fauziah Hospital. These results suggest that fibrinolytic success is likely influenced by other factors, such as timing of drug administration, protocol adherence, and individual variation in response to therapy. Further research with a larger sample size and a prospective design is recommended to strengthen these findings.

Acute Coronary Syndrome (ACS) is an emergency condition in which a group of symptoms of acute ischemic chest pain are part of coronary heart disease (CHD) and require immediate treatment. The prevalence of CHD in Aceh is higher than the national average of 1.6% or around 20,244 people. This study is expected to describe the prevalence, number of deaths (mortality) and average length of stay (LOS) of STEMI patients during hospitalization so that this data can significantly enhance knowledge for health practitioners and be used as a warning to be more aware of STEMI incidents in Aceh. This study uses a retrospective descriptive research design with a research sample of all patients diagnosed with ACS with ST-Elevation who were hospitalized at Dr. Fauziah Hospital in June 2022-June 2023. The data collection technique is total sampling obtained from medical record data. It was concluded that the majority of patients were male, namely 80.7% (71 patients), the highest age was 45-60 years with 45 cases (51.1%). History of CHD was the dominant risk factor (62% of cases). The most dominant type of ACS with ST-Elevation was Anterior STEMI as many as 32 cases (52.3%) with onset <12 hours (51% of cases) and predominantly came with KILLIP I (62.5% of cases). The most dominant management was with conservative therapy 56 cases (61.4%). The average length of patient care was 5 days (45.1%) and the most outcomes with outpatients as many as 72 cases (81.8%).

Symptoms of stemi can cause patients to feel more anxious, this anxiety can be overcome pharmacologically and nonpharmacologically. However, pharmacological therapy can cause various side effects. Therefore, nonpharmacological therapies can be recommended including progressive relaxation techniques. The purpose of this study was to determine the application of progressive muscle relaxation therapy to anxiety using the HARS scale in stemi patients in the CVCU Room of Prof. Aloei Saboe Hospital. Pre-experimental research method with one group pre post test design, a sample of 4 people who met the sample criteria, the instrument used HARS (Hamilton Anxiety Rating Scale) and the data analysis used was univariate analysis. The study findings are that progressive relaxation techniques carried out by researchers for 3 days can reduce the HARS score of the first patient from a score of 11 to 4, the second patient from a score of 12 to 6, the third patient from a score of 13 to 7 and the fourth patient from a score of 12 to 6, so that progressive muscle relaxation therapy can be applied in reducing anxiety of stemi patients in the CVCU Room of Prof. Aloei Saboe Hospital. The implication of this study is that the nursing profession is expected to improve the provision of nursing interventions in carrying out the nursing care process comprehensively, namely from bio to psychosocial patients so that it can help patients overcome psychosocial problems in this case the anxiety experienced by patients.