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Acute Coronary Syndrome PowerPoint Presentation

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Description : Check out this medical presentation on Angina, which is titled "Acute Coronary Syndrome", to know about Acute Coronary Syndrome.

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Published on : May 25, 2021 | Views : 12011 | Downloads : 218

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Slide 1-

Acute Coronary Syndrome Carrie Hurst FY1
Slide 2-

What we’ll cover in next 30 mins… Definitions Clinical features and differentiating ACS ECGs Management Complications Some tips from a 2013 Warwick grad Case study
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What is Acute Coronary Syndrome? Stable Angina Unstable Angina NSTEMI STEMI
Slide 4-

Definitions Unstable angina: An unprovoked or prolonged episode of chest pain raising suspicion of acute myocardial infarction (AMI) Without definite ECG or laboratory evidence NSTEMI: Chest pain suggestive of AMI Non-specific ECG changes (ST depression/T inversion/normal) Laboratory tests showing release of troponins STEMI: Sustained chest pain suggestive of AMI Acute ST elevation or new LBBB * ALS handbook 6th Edn
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Pathophys (enough to get by..) Atherosclerosis Epithelial injury Migration of monocytes/macrophages LDL lipids consumed  foam cells Growth factors  smooth muscle, collagen, proteoglycans Atheromatous plaque forms
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Clinical features Dyspnoea Heart murmurs Palpitations Chest pain Nausea Acute confusion Pallor Hypotension or hypertension Sweaty Vomiting Syncope Indigestion Tachycardia or bradycardia Fever Asymptomatic/silent
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Distinguishing features UA: platelet adhesion NSTEMI: platelet aggregation STEMI: complete occlusion SA: plaque formation At rest or minimal exertion Lasts >20 minutes Often accompanied by other s/s Poor GTN relief Precipitated by stress or exertion Lasts <20 minutes Relieved by GTN or resting
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Risk Factors Modifiable Non-Modifiable Increasing age Gender (male) Ethnicity Family History ?Diabetes Smoking Obesity Diet Lack of exercise High serum cholesterol Hypertension ? Diabetes
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Differential Diagnosis
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Investigations * ST elevation is >1mm in limb leads and >2mm in chest leads
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Important ECG findings
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Where is the problem?
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Management
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Common ACS management Morphine (5-10mg slow IV injection) Oxygen (titrate sats to need) Nitrates - GTN spray (400mcg = 1 spray) or tablet (1mg) Aspirin (300mg chewed) Plus an antiemetic i.e. Metoclopramide 10mg IV * BNF 64
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Unstable angina & NSTEMI LMWH i.e. Enoxaparin 1mg/kg BD or Fondaparinux 2.5mg OD Clopidogrel 300mg loading dose Beta blocker - atenolol 5mg Nitrates – usually IV Consider coronary angiography within 72 hr
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Scoring systems GRACE scoring Predicts 6/12 mortality in NSTEMI patients Age HR and systolic BP Killip class (CCF, pulmonary oedema, shock) Cardiac arrest on admission Elevated cardiac markers ST segment change TIMI Risk of cardiac events in next 30 days Age >65 Known coronary artery disease Aspirin in last 7/7 Severe angina (>2 in 24hr) ST deviation >1mm Elevated troponins > CAD risk factors
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STEMI TIME IS MUSCLE Percutaneous coronary intervention (Primary PCI) ‘Call to balloon time’ of 120 minutes Requires clopidogrel 600mg loading dose Rescue PCI after failed thrombolysis Thrombolysis Streptokinase / alteplase / tenecteplase… Contraindications Clopidogrel 600mg loading dose AND LMWH Beta blocker i.e. Atenolol ACE inhibitor i.e. Lisinopril
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Longer-term management Continuous ECG monitoring as inpatient/ CCU Aspirin 75mg OD (lifelong) Clopidogrel 75mg (1 year) Beta blocker (1 year - lifelong) ACE inhibitor Statin Modification of risk factors
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Complications Early <72hr Death Cardiogenic shock Heart failure Ventricular arrhythmia Myocardial rupture Thromboembolism Late Ventricular wall rupture Valvular regurgitation Ventricular aneurysms Cardiac tamponade Dresslers syndrome Thromboembolism
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How to say the right thing in clinicals…. Have a system!! “I would order bedside, blood, imaging and special test….” “ I would check that the patient is haemodynamically stable using an A-E approach” “My management strategy would take into account conservative, medical and surgical…” NEVER GUESS You get more marks for knowing your limitations than for knowing an obscure fact. They want to know you’ll be a safe F1
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Case study – Mr FB A 54 year old gentleman presents to A&E with chest pain…
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What do you want to ask him? 30minute history of central ‘crushing’ chest pain radiating to his jaw and left arm, 10/10 He is SOB, looks very pale, clammy and sweaty, and has vomited twice PMHx of hypertension and hypercholesterolaemia Takes metformin, salbutamol inhalers and citalopram FHx includes father dying of MI aged 50 Smoked 40 cigarettes a day for the past 35 years and drinks a bottle of whiskey a week Cant exercise “because of my asthma”
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What are his risk factors? Increasing age Gender (male) Family History Smoking Obesity Diet Lack of exercise High serum cholesterol ? Hypertension ?Diabetes
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How would you Ix him?
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Case study – Mr FB Initial management in acute setting? MONA Reperfusion BB and ACEi Long-term management? Aspirin, Clopidogrel, Statin, modification of lifestyle…..
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Summary Don’t forget to learn what you think you already know! ECG often Structured approach Know your acute management – MONA Senior review is always the right answer
Slide 28-

References BNF 64 Advance Life Support emodule handbook 6th Edition OHCS 7th Edition Great ECG example website: www.meds.queensu.ca/central/assets/modules/ECG/ecg_index.html