Acute coronary syndrome - Revision history

Aidan at 12:22, 2 August 2020

2020-08-02T12:22:02Z

← Older revision		Revision as of 12:22, 2 August 2020
Line 1:		Line 1:
	== ~~Definition~~ ==		== 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

			*Spectrum of syndromes resulting from myocardial ischemia
	== Consensus Classification of Myocardial Infarction (MI) ==
			**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

			*'''Type 1:''' spontaneous MI from plaque rupture, dissection, etc
	== Etiology ==
			*'''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

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

			==Clinical Manifestations==
	* History
	* Signs & Symptoms
	* RV infarct will present with
	** Hypotension
	** Right heart failure

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

			=== Complications ===
	* 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)

			*[[Cardiogenic shock]]
	== Management ==
			*LV aneurysm: clot, [[ventricular fibrillation]], [[ventricular tachycardia]]
			*Ischemic [[mitral regurgitation]]
			*Dynamic outflow obstruction
			*Rupture: early (<24h) or late (<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==
	* TNK 0.53mg/kg IV bolus then transfer to PCI centre
	* If RV infarct
	** Fluids and fluids
	** Consider inotropes

			*EKG
	== Complications ==
			**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==
	* Cardiogenic shock

	* LV aneurysm: clot, VF, VT
			*TNK 0.53mg/kg IV bolus then transfer to PCI centre
	* Ischemic mitral regurgitation
			*If RV infarct
	* Dynamic outflow obstruction
			**Fluids and fluids
	* Rupture: early (<24h) or late (<7d)
			**Consider inotropes
	** Posterior papillary rupture
	*** No murmur, but acutely looks very unwell with large V-wave
	*** Needs urgent MVR
	* VSD
	* Free wall rupture: tamponade or PEA

	[[Category:Cardiology]]		[[Category:Cardiology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:17:13Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:17, 14 July 2020
Line 25:		Line 25:
	* Stenosis: luminal narrowing from progressive atherosclerotic disease		* Stenosis: luminal narrowing from progressive atherosclerotic disease

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* History		* History

Aidan at 20:43, 5 July 2020

2020-07-05T20:43:16Z

← Older revision		Revision as of 20:43, 5 July 2020
Line 44:		Line 44:
	** Coronary angiogram		** Coronary angiogram
	** Myocardial perfusion (MIBI)		** Myocardial perfusion (MIBI)

	![Cardiac enzymes](Cardiac enzymes.png)

	== Management ==		== Management ==

Maintenance script: Imported from text file

2020-07-04T01:17:20Z

Imported from text file

New page

== 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 Presentation ==

* History
* Signs & Symptoms
* RV infarct will present with
** Hypotension
** Right heart failure

== 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)

![Cardiac enzymes](Cardiac enzymes.png)

== Management ==

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

== Complications ==

* Cardiogenic shock
* LV aneurysm: clot, VF, VT
* Ischemic mitral regurgitation
* Dynamic outflow obstruction
* Rupture: early (<24h) or late (<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

[[Category:Cardiology]]