Acute Coronary Syndrome
Acute Coronary Syndrome
Acute Coronary Syndrome
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Stable Angina = Ischaemic Heart disesase
STABLE
ANGINA
A GUIDE TO RISK STRATIFICATION IN STABLE ANGINA
HIGH RISK LOW RISK
STE-ACS… ST-elevation
Consider
'culprit
lesion’
PCI
Medical
Therapy
No
Myocardial infarction
Epidemiology of NSTE and STEMI-ACS
The annual incidence of NSTE-ACS is higher
than STEMI
The annual incidence of hospital admissions for
NSTE-ACS is in the range of 3 per 1000
inhabitants
Sex differences - men account for more than
90% of patients with AMI at the age under 40yrs
(protective effect of female hormones)
• Age differences - in patients aged under 40yrs
only one artery to heart is affected
Myocardial infarction
Aetiology:
1. Atherosclerotic aetiology
2. Non-atherosclerotic aetiology:
arteritis
trauma
dissection
congenital anomalies
cocaine abuse
complications of cardiac catheterization,
CABG
Diagnosis of acute MI
At least 2 from 3 criteria must be fulfilled :
• Clinical symptoms
– Chest pain
• ECG changes
– ST elevation or depression
– negative T wave
• Elevated cardiac biomarkers
– Troponin I or T
– CK-MB
– Myoglobin
Clinical presentation
Prolonged chest (retrosternal) pain
Anxiety and fear of impending death
Nausea, vomiting
Breathlessness
Collapse/syncope
Clinical presentation(diagram rep.)
1) Typical chest pain
2) Nausea
3) Sweating
Clinical presentation
The presence of tachycardia, hypotension, or
heart failure needs rapid diagnosis and
management, often indicating a poor prognosis
of this patient with ACS
It is important to identify the clinical
circumstances such as anaemia, infection,
inflammation, fever, and metabolic or endocrine
(in particular thyroid disorders)
(may exacerbate or precipitate ACS)
Physical examination
Frequently normal
S1 muffled, S3 present
CABG: