View source for Acute coronary syndrome

== Background ==

===Definition===

*Spectrum of syndromes resulting from myocardial ischemia
**Unstable angina: no biochemical or EKG abnormalities, but increasing anginal symptoms
***New-onset, severe angina
***Angina at rest
***Early post-MI angina
***Post-revascularization angina
**NSTEMI: biochemical abnormalities with or without EKG abnormalities
**STEMI: biochemical abnormalities with ST elevation in 2 or more contiguous leads

===Consensus Classification of Myocardial Infarction (MI)===

*'''Type 1:''' spontaneous MI from plaque rupture, dissection, etc
*'''Type 2:''' demand ischemia
*'''Type 3:''' likely MI but patient died before biomarkers were drawn
*'''Type 4'''
**'''Type 4a:''' PCI-related MI
**'''Type 4b:''' stent thrombosis
*'''Type 5:''' CABG-related MI

===Etiology===

*Thrombosis: rupture of atherosclerotic plaque resulting in thrombus formation that occludes the lumen
*Stenosis: luminal narrowing from progressive atherosclerotic disease

==Clinical Manifestations==

*Angina
*RV infarct will present with
**[[Hypotension]]
**Right heart failure

=== Complications ===

*[[Cardiogenic shock]]
*LV aneurysm: clot, [[ventricular fibrillation]], [[ventricular tachycardia]]
*Ischemic [[mitral regurgitation]]
*Dynamic outflow obstruction
*Rupture: early (&lt;24h) or late (&lt;7d)
**Posterior papillary rupture
***No murmur, but acutely looks very unwell with large V-wave
***Needs urgent MVR
*VSD
*Free wall rupture: tamponade or PEA

==Investigations==

*EKG
**If concern for inferior STEMI, get a 15-lead to rule out RV infarct
*Labs
**Troponin
**CK
**AST
*Imaging
**Coronary angiogram
**Myocardial perfusion (MIBI)

==Management==

*TNK 0.53mg/kg IV bolus then transfer to PCI centre
*If RV infarct
**Fluids and fluids
**Consider inotropes

[[Category:Cardiology]]