Acute Coronary Syndrome

Extract

[...] Acute Coronary Syndrome - Spectrum of acute ischemia related syndromes. - Stenosis in the coronary artery or a thrombus maybe present causing partial occlusion of the artery. Leading to MI (STEMI or NSTEMI) - Stable angina ? Unstable angina ? STEMI q NSTEMI & all share the same pathophysiology. - Pt at risk of MI - Prinzmetal's angina ? in Female d/t vasospasm of the coronary artery. Signs & Symptoms: i. Chest pain =angina on exertion (main main symptom) ? [...]

[...] Surgery ? during CABG vi. In stent thrombosis Investigations: i. History ECG changes Cardiac markers Then after investigations, classify the pt for Diagnosis: Unstable angina NSTEMI STEMI Stenosis of the artery (No thrombus) Thrombosis is there & a part of the fibrous cap rutured causing the platelet to adhere & aggregate. This partially occlude the artery. So no changes in heart tissue. Complete artery occlusion by the thrombosis & platelet aggregation. No ECG changes On ECG: ST- depression T-wave inversion On ECG: ST elevation LBBB Normal cardiac enzymes High cardiac enzyme (troponin levels are high) CK-MB high All cardiac enzymes are high. [...]

[...] acute heart failure Ca2+ blocker who cant take beta blocker NSAIDs + Cox-2 X As they are contra with aspirin Bed rest ACE inhibitor for heart failure Statins Drugs: ASPIRIN CLOPIDOGREL / TICAGRELOR GP2b3a X Unfractinated HEPARIN ENOXAPARIN BIVALARUDIN FONDAPARINUX Other causes for elevated Troponin: i. Trauma ii. Congestive ??failure (acute and chronic) iii. Aortic valve disease and HOCM with significant L VH iv. HTN v. Hypotension, often with arrhythmias vi. Non cardiac surgery vii. Renal failure viii. Critically ill patients, especially with diabetes, respiratory failure ix. Drug toxicity adriamycin FU, herceptin, snake venoms) x. [...]

[...] Coronary vasospasm, including apical ballooning syndrome xii. Inflammatory diseases myocarditis, Kawasaki disease, smallpox vaccination) xiii. Post-PCI xiv. PE, severe pulmonary hypertension xv. Sepsis xvi. Burns, especially if TBSA greater than 30% xvii. Infiltrative diseases: amyloidosis, hemochromatosis, sarcoidosis, and scleroderma xviii. Acute neurologic disease, including CVA, subarchnoid bleeds xix. Rhabdomyolysis with cardiac injury xx. Transplant vasculopathy xxi. Vital exhaustion Stenosis It has svereti:- Mild or sever = unstable angina or NSTEMI Vasospasm ? prinzmetal's angina Female Have atherosclerosis ECG changes - ST segment elevation > 1mm consecutively - Q-waves - Conduction defect ? [...]