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## New Onset Severe Angina - Increasing angina - Previously dx angina that's become more frequent, longer ## ECG: - 12 lead should be obtained within 10 mins of ED arrival - ST segment changes represent acute cardiac ischemia - Determine ST segment changes (≥ 0.05 mV) or T-wave inversio...

## New Onset Severe Angina - Increasing angina - Previously dx angina that's become more frequent, longer ## ECG: - 12 lead should be obtained within 10 mins of ED arrival - ST segment changes represent acute cardiac ischemia - Determine ST segment changes (≥ 0.05 mV) or T-wave inversion in 2 or more contiguous leads - Provides location and size of infarct - Areas of infarction do not produce electrical activity - Changes in T wave are first manifestation of acute coronary occlusion (ischemia) - T wave inversion - Followed by ST segment changes - ST segment depression, ST segment elevation - ST segment depression indicates lengthening of repolarization = NSTE- ACS - not fully occluded - ST segment elevation - indicated injury from ischemia extending from subendocardial region to subepicardial region - transmural ischemia - Indicative of STEMI and fully occluded vessel ## LABS: - Cardiac troponin - preferred biomarker - Levels don't begin to rise until 6 hrs POST MI - May last up to 10-14 days - Creatine Kinase MB fraction (CK-MB) and myoglobin - less sensitive for myocardium and are not recommended anymore - BNP - can add this ## **If no cardiac biomarkers** → unstable Angina ## **If positive cardiac biomarkers** → NSTEMI