Acute coronary syndrome (main)
Revision as of 19:45, 8 February 2014 by Ostermayer (talk | contribs)
Background
ACS is three diseases involving the coronary arteries:
- ST-Elevation Myocardial Infarction (STEMI) (30%)
- Non ST-Elevation Myocardial Infarction (NSTEMI) (25%)
- Unstable Angina (38%)
Types of Myocardial Infarction
- Type 1: Ischemic myocardial necrosis due to plaque rupture ( ACS)
- Type 2: Ischemic myocardial necrosis due to supply-demand mismatch, e.g. coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias.
- Type 3: sudden cardiac death (no cTr values)
- Type 4: procedure related, post PCI or stent thrombosis ( cTr > 5X Decision Level).
- Type 5 post CABG (cTr > 10X Decision Level).
DDx
Diagnosis
Clinical factors that increase likelihood of ACS/AMI:
- Chest pain radiating both arms >R arm >L arm
- Chest pain associated with diaphoresis
- Chest pain associated with N/V
- Chest pain with exertion
Clinical factors that decrease likelihood of ACS/AMI:
- Pleuritic chest pain
- Positional chest pain
- Sharp, stabbing chest pain
- Chest pain reproducible with palpation
- ECG (Diagnosis)
- ECG is normal in 8% of all confirmed MI's
- In LBBB see Sgarbossa's Criteria
- Cardiac Enzymes
- ACS - Risk Stratification
- ACS - Anatomical Correlation
Treatment
Intensity of Rx should be based on likelihood that sx are due to acute coronary thombosis
- ST-Elevation Myocardial Infarction (STEMI)
- Non ST-Elevation Myocardial Infarction (NSTEMI)
- Unstable Angina
Disposition
- Admit all ACS pts