Acute Coronary Syndrome

Kumr & Clark P: 1079-1091

Internal Medicine

Acute Management

all simultaneously

• Efficient & direct history
• Initiate stabilization interventions
• Plan for further cardiac care

Remember important Life threatening conditions causing chest pain

• They
• Can’t
• Misses

Initial Approach

Chest pain suggestive of ischemia

Immediate assessment within 10 Minutes

Initial Labs and Tests

• 12 lead ECG
• Obtain initial cardiac enzymes
• electrolytes, cbc lipids, bun/cr, glucose, coags
• CXR

Emergent care

• History & Physical
• IV access
• Cardiac monitoring
• Oxygen
• Aspirinx
• nitrates & nitritesx

history & Physical

• Establish diagnosis
• Read ECG
• Identify complications
• Assess for reperfusion

ECG Readings

Coronary Artery

COMMENT ON ECG

• ST ELEVATION IN LEAD  II , III, aVF
• INFERIOR MI

Posterior MI

0.5 mm or 0.05 mV

Investigations

• Troponin T and I: highest sensitivity and specificity for detecting MI; appear within 4 hours; peak at 24 to 48 hours and decline slowly; remain 7 to 10 days

• Creatine phosphokinase myocardial band (CPK-MB): first measurable at 6 to 10 hours; peaks at 24 hours; baseline by 48 to 72 hours

Acute coronary syndrome classification

• STEMI

• NSTEMI

• Unstable Angina

ACS Case scenarios