week 10 Acute Coronary Syndromes (ACS).pdf

Due to total occlusion of the coronary...

Due to total occlusion of the coronary artery ST-elevation ACS (STEACS): ST-elevation myocardial infarction (STEMI) ST elevation or new left bundle branch block (LBBB) The definition of ACS includes: NSTEACS is due to a partial occlusion of Non-ST-elevation ACS (NSTEACS): the coronary artery, with T-wave inversion Differentiation of UA & NSTEMI is Unstable angina (UA) and NSTEMI and/or ST depression determined by the troponin Terminology All have a similar presentation and result from plaque disruption and thrombus formation The primary difference is the degree of obstruction and necrosis Signs of STEACS in LBBB Sgarbossa Arrhythmia: Ionic and biochemical alterations leading to unstable electrical substrate and ventricular tachyarrhythmias Consequences of Myocardial Ischemia Cell death: Apoptosis and necrosis Pump failure: Impairment of myocardial contraction and relaxation Aortic dissetion PE Non-ACS Causes of cTn Elevation STROKE SEPSIS Hypoxia CHEST PAIN!! may radiate to the left arm, jaw, back , SOB/dyspnea Cool, sweaty, Presentation clammy, pale- Lightheaded Episodes of ischemia in the absence of chest pain, present with anginal equivalents Silent Ischemia Specific populations at risk include diabetics, women, women with heart failure, hypertension, and chronic renal disease/end-stage renal disease Non-modifiable: Family history, A&TSI, increasing age (females), male sex Modifiable: Smoking, hypertension, diabetes, dyslipidemia, obesity, obstructive sleep apnea Risk Factors Contributing factors: Sedentary lifestyle, stress, depression Obstetric history: Placental abruption, stillbirth, hypertensive disorders, gestational diabetes, preterm birth Ischemic CV causes: ACS, stable angina, severe aortic stenosis, tachyarrhythmia Non-CV causes: Gastrointestinal, Differential Diagnosis musculoskeletal, pulmonary, herpes zoster Non-ischemic CV causes: Aortic dissection, expanding aortic aneurysm, pulmonary Acute Coronary embolism, peri/myocarditis Syndromes (ACS) Early access to a defibrillator prevents sudden cardiac death ¢Aspirin (300mg) should be given early ¢Where appropriate, a 12-lead ECG should be taken en route & transmitted to a medical facility. Getting to the hospital ¢Where formal protocols are in place, Acute Management of Chest prehospital treatment (including Pain fibrinolysis ECG within 10 minutes, continuous ECG in appropriate monitoring, cases) venousshould access,beaspirin, facilitated pain On arrival to the hospital relief, blood tests, and chest ¢Pre-hospital activation of the CODEX-ray, Oxygen therapy * SpO2