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    Acute Coronary Syndromes: by DR N Aravinthan

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    suba
    The document discusses acute coronary syndromes, including their pathophysiology, clinical presentations, diagnosis, and management. Key risk factors for premature coronary artery narrowing include smoking, hypertension, hypercholesterolemia, diabetes, obesity, and family history. Clinical scenarios include stable angina, unstable angina, and myocardial infarction. Diagnosis involves obtaining a history, electrocardiogram changes, and elevated cardiac enzymes. Management consists of measures to relieve chest pain, antiplatelet therapy, beta blockade, ACE inhibitors, and reperfusion therapy using thrombolytics or percutaneous coronary angioplasty. Early complications can include mechanical issues, arrhythmias, and cardiac pump failure.

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    Acute Coronary Syndromes: by DR N Aravinthan

    Uploaded by

    suba
    18 views21 pages
    The document discusses acute coronary syndromes, including their pathophysiology, clinical presentations, diagnosis, and management. Key risk factors for premature coronary artery narrowing include smoking, hypertension, hypercholesterolemia, diabetes, obesity, and family history. Clinical scenarios include stable angina, unstable angina, and myocardial infarction. Diagnosis involves obtaining a history, electrocardiogram changes, and elevated cardiac enzymes. Management consists of measures to relieve chest pain, antiplatelet therapy, beta blockade, ACE inhibitors, and reperfusion therapy using thrombolytics or percutaneous coronary angioplasty. Early complications can include mechanical issues, arrhythmias, and cardiac pump failure.

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    Active Coronary Syndroms

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    The document discusses acute coronary syndromes, including their pathophysiology, clinical presentations, diagnosis, and management. Key risk factors for premature coronary artery narrowing include smoking, hypertension, hypercholesterolemia, diabetes, obesity, and family history. Clinical scenarios include stable angina, unstable angina, and myocardial infarction. Diagnosis involves obtaining a history, electrocardiogram changes, and elevated cardiac enzymes. Management consists of measures to relieve chest pain, antiplatelet therapy, beta blockade, ACE inhibitors, and reperfusion therapy using thrombolytics or percutaneous coronary angioplasty. Early complications can include mechanical issues, arrhythmias, and cardiac pump failure.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    18 views21 pages

    Acute Coronary Syndromes: by DR N Aravinthan

    Uploaded by

    suba
    The document discusses acute coronary syndromes, including their pathophysiology, clinical presentations, diagnosis, and management. Key risk factors for premature coronary artery narrowing include smoking, hypertension, hypercholesterolemia, diabetes, obesity, and family history. Clinical scenarios include stable angina, unstable angina, and myocardial infarction. Diagnosis involves obtaining a history, electrocardiogram changes, and elevated cardiac enzymes. Management consists of measures to relieve chest pain, antiplatelet therapy, beta blockade, ACE inhibitors, and reperfusion therapy using thrombolytics or percutaneous coronary angioplasty. Early complications can include mechanical issues, arrhythmias, and cardiac pump failure.

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    Acute coronary

    Syndromes
    By
    Dr N Aravinthan
    Pathophysiology
    Factors those encourages the premature
    coronary arteries narrowing
    a) Smoking
    b) Hypertension
    c) Hypercholesterolemia
    d) Diabetes mellitus
    e) Obesity
    f) Family history

    12/07/2021 2
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    Clinical scenarios
    A. Stable angina
     Only occurs with exercise
     Pain last for < 30ml
    B. Unstable angina
     Typical chest pain at rest
     Pain last for < 30min
    C. Myocardial infarction
     Un remitting , lasting several hours
     Sweating, nausea
     Sometimes vomiting and breathlessness

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    Diagnosis of MI

    a. Typical history
    b. ECG changes
    c. Elevation of serum cardiac
    enzymes

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    ECG
    • Complete occlusion of coronary artery causing
    full thickness MI(STEMI)
    • Partial occlusion-ST depression/ T-wave
    inversion(NSTEMI)
    • Site of MI suggested by the ECG- important
    prog-significant
    • E.g. Anterior MI – V2-V4 leads changes
    • Occlusion of left anterior descending artery
    • Lead to left ventricle wall affected – worse prognosis

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    Cardiac enzymes elevation
    • Troponins- I and T- prolong release pattern up
    to 10 days. They are more cardiac specific
    • However not specific for ischemic injury
    E.g. – myocarditis, pulmonary embolus
    and arrhythmias
    • CK –MB-best use in find out timing of an
    infarct or size of the infarct

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    Other investigations

    Echo - regional wall motion abnormality


    ventricular septal defect etc

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    Mx-routine measures
    A. Relieve chest pain
     Nitroglycerin(0.4mg sublingual tablets or aerosol spray) given up
    to 3 doses
     If chest pain persist
     Morphine 5 mg given by slow IV; can be repeated every 5 to 10 min
    B. Antiplatelet therapy
     Chewable aspirin 150-300mg-irreversible inhibition of platelet
    aggregation. this initial dose fallowed by 75-150 mg daily dose
     Clopidogrel –inhibit ADP-mediated platelet aggregations 300mg
    fallowed by 75mg daily
     Combined therapy with both-have very law mortality than each
    alone

    12/07/2021 10
    Mx cont……..
    • β receptor blockade atenolol and metoprolol
    Recommended for all ACS patients except those
    with bradycardia
    Oral therapy is suitable for most cases
    IV form to pt with HT or Tachyarrhythmias
    Oral- 50mg every 6 hours for 48 hours.
    Iv form – add 5 mg metoprolol to 50 ml DW and infuse
    over 15-30min. Repeat every 6 hours

    12/07/2021 11
    Mx cont…..
    o ACE inhibitors
    o – reduce cardiac work
    o also useful in inhibition of post MI cardiac
    remodeling
    o Can be useful in all patient except severe
    hypotension, SK > 2.5 mg/all and bilateral
    renal artery stenosis
    o Oral therapy only recommended doses 5 mg
    enalapril/D

    12/07/2021 12
    Reperfusion therapy
     thrombolytic
     mechanical

    12/07/2021 13
    Thrombolytic
    Indications
     Onset of chest pain within 12 hours
     12 lead ECG shows ST elevation in two
    contiguous leads or a new left bundle branch
    block
     Coronary angioplasty not immediately available
     No hypotension or evidence of heart failure
     No contraindication to thrombolytic therapy

    12/07/2021 14
    Contraindications to thrombolytic therapy
    • Absolute
    previous hemorrhagic stroke
    Any stroke within previous 2 months
    Intracranial neoplasm
    Active bleeding within previous month(except menstrual)
    aortic dissection
    Major surgery in last 3 weeks
    • Relative
    – Stroke > 2 months < 1 2months
    – Pregnancy
    – Active peptic ulcer disease
    – Serve hypertension on presentation(> 180/110 mm hg)
    – Surgery/trauma within previous month
    – Bleeding diathesis
    – CPR > 10 min
    – Non compressible vascular puncture
    – allergy

    12/07/2021 15
    Plasminogen
    Thrombolytic agents
    Plasmin Bresks tinrin
    strands

    Agent Dose comments


    Streptokinase 1.5 million UTV over 60 First thrombolytic agent
    (SK) min Side effects – fever, allergic
    reaction etc

    Alteplase (TPA) 15 mg IV holus Most frequently used


    +0.75 mg/kg – 30 min Fewer side effects
    +0.75 g/kg – 60 min

    Reteolase 10 unit in holus repeat in Rapid clot lysis than TPA bolus
    30 min doses – easier to give

    12/07/2021 16
    Problems with thrombolytic agents
    A. bleeding
    * Systemic fibrinolysis with depletion of circulating fibrinogen levels
    * Interacerebral haemorrhages 0.5 –1%
    * Severe bleeding- treated with cryoprecipitate, fresh frozen plasma,
    antifribrinolytic agents – epsilon – aminocaproic acid
    B. Re occlusion – this risk can be treated with antithrombotic
    therapy
     Asprin – inhibit formation of thromboxane
     Platelet glycoprotein inhibitors – inhibit platelet aggregations Eg
    tirofiban, abciximab
     ADP mediated platelet inhibitors - clopidogrel

    12/07/2021 17
    Percutaneus coronary angioplasty
    • Use of balloon tipped catheters with or
    without a stent to open occluded arteries
    • Several clinical trials shows PCA having
    reduction in both mortality rate and rein
    -farction rate than thrombolytic therapy who
    present within 12 hours

    12/07/2021 18
    Early complications of ACS
    I. Mechanical
    a) Acute mitral regurgitation – result of papillary
    muscle rupture
    b) Ventricular septal rupture
    c) Ventricular free wall rupture
    II. Arrhythmias
    III. Cardiac pump failure

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    Thank you very
    much for listening

    12/07/2021 21

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