Acute coronary syndrome
- 1. ACUTE CORONARY SYNDROME BY SUJA S KUMAR
- 2. ACUTE CORONARY SYNDROME • Classified into 2 groups • STEMI • NSTE-ACS – NSTEMI – Unstable angina
- 5. NSTE-ACS
- 6. PATHOPHYSIOLOGY • NSTE-ACS • Imbalance between myocardial O2 supply and demand due to 1 or more of the following: – 1.disruption of an unstable coronary plaque due to plaque rupture,erosion,/calcified protruding nodule- intracoronary that lead to intracoronary thrombus formation and inflamatory process – 2.coronary arterial vasoconstriction – 3.gradual intraluminal narrowing – 4.fever,tachycardia, thyrotoxicosis in presence of fixed epicardial coronary obstruction
- 9. CLINICAL PRESENTATION • Chest discomfort – Occurrence at rest/with minimal exertion lasting >10 min – Relatively recent onset – Cresendo pattern – ie; distinctly more severe , prolonged ,frequent than previous episode
- 11. ECG • New ST segment depression • May be transient • But last for several days follwing NSTEMI • T wave changes :common , but less specific • Unless new and deep T wave inversion(>/=0.3mV)
- 12. CARDIAC BIOMARKERS • ELEVATED BIOMARKERS OF NECROSIS: – CARDIAC TROPONIN(cTn) I or T – CK -MB
- 14. DIAGNOSTIC EVALUATION • ECG • Cardiac biomarkers • Stress testing • CCTA • Goals: – Recognise & exclude MI- cardiac biomarkers,cTn – Detect rest ischemia-ECG – CCTA to detect coronary obstruction at rest
- 15. TREATMENT • Medical treatment • Anti Ischemic treatment • Anti thrombotic therapy • Anti platelet • Anticoagulant
- 20. PRINZMETAL’S ANGINA • Syndrome of severe ischemic pain • Usually occur at rest • Associated with transient ST segment elevation • Caused by focal spasm of an epicardial coronary artery and transmural ischemia and abnormalities in left ventricular function • Leading to acute MI, VT/VF ,sudden cardiac death
- 21. TREATMENT • Nitrates • Calicium channel blockers • Statin therapy reduces the risk of major adverse events • Coronary revasularization
- 22. ST SEGMENT ELEVATION MI- STEMI • Coronary blood flow decreases abruptly
- 23. CLINICAL FEATURES • Precipitating factors – Vigorous physical exercise – Emotional stress/medical/surgical illness • Pain: deep and visceral Heavy,squeezing,& crushing/stabbing/burning Occurs at rest More severe & last longer Central portion of chest &/epigastrium Radiates weakness • Sweating,nausea,vomiting,anxiety,sense of impending doom
- 24. PHYSICAL FINDINGS • Anxious and restless • Substernal chest pain > 30 min, • Diaphoresis • Anterior infarction: sympethetic N.S. hyperactivity • Precordium : quiet, apical impulse difficult to palpate • Anterior wall infarction :abnormal systolic pulse
- 25. LAB PARAMETERS • ECG • Serum cardiac biomarkers • Cardiac imaging
- 27. INITIAL MANAGEMENT • Prognosis depends on occurrence of complications: – Electrical complications(Arrythmias) and mechanical complications (pump failure • Prehospital care: – Recognition – Medical team and resuscittion – Expeditous transportation of patient – Expeditious implementation of reperfusion therapy
- 28. MANAGEMENT IN EMERGENCY DEPARTMENT • Cardiac discomfort – Sublingual nitroglycerin 0.4 mg – Morphine – IV beta blockers • Identify candidates for urgent reperfusion therapy • Limitation of infarct size – Primary Percutaneous Coronary intervention – Fibrinolysis – Integrated reperfusion strategy
- 30. HOSPITAL PHASE MANAGEMENT • Coronary care units • Activity • Diets • Bowel management • Sedation
- 31. PHARMACOTHERAPY • Antithrombotic agents • Beta adrenoceptor blockers • Inhibition of RAAS
- 32. COMPLICATIONS AND ITS MANAGEMENT • Ventricular dysfunction • Hemodynamic assesment • Hypovolemia
- 33. THANK YOU