Acute coronary syndrome: Difference between revisions

Latest revision as of 12:22, 2 August 2020

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 (<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

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

@@ 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 Presentation ==
+*Stenosis: luminal narrowing from progressive atherosclerotic disease
+==Clinical Manifestations==
-* History
-* Signs &amp; 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 (&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==
-* 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 (&lt;24h) or late (&lt;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]]