Acute coronary syndrome: Difference between revisions
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| − | == |
+ | == Background == |
| + | ===Definition=== |
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| − | * Spectrum of syndromes resulting from myocardial ischemia |
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| − | ** Unstable angina: no biochemical or EKG abnormalities, but increasing anginal symptoms |
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| − | *** New-onset, severe angina |
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| − | *** Angina at rest |
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| − | *** Early post-MI angina |
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| − | *** Post-revascularization angina |
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| − | ** NSTEMI: biochemical abnormalities with or without EKG abnormalities |
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| − | ** STEMI: biochemical abnormalities with ST elevation in 2 or more contiguous leads |
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| + | *Spectrum of syndromes resulting from myocardial ischemia |
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| − | == Consensus Classification of Myocardial Infarction (MI) == |
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| + | **Unstable angina: no biochemical or EKG abnormalities, but increasing anginal symptoms |
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| + | ***New-onset, severe angina |
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| + | ***Angina at rest |
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| + | ***Early post-MI angina |
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| + | ***Post-revascularization angina |
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| + | **NSTEMI: biochemical abnormalities with or without EKG abnormalities |
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| + | **STEMI: biochemical abnormalities with ST elevation in 2 or more contiguous leads |
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| + | ===Consensus Classification of Myocardial Infarction (MI)=== |
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| − | * Type 1: spontaneous MI from plaque rupture, dissection, etc |
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| − | * Type 2: demand ischemia |
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| − | * Type 3: likely MI but patient died before biomarkers were drawn |
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| − | * Type 4 |
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| − | ** Type 4a: PCI-related MI |
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| − | ** Type 4b: stent thrombosis |
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| − | * Type 5: CABG-related MI |
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| + | *'''Type 1:''' spontaneous MI from plaque rupture, dissection, etc |
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| − | == Etiology == |
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| + | *'''Type 2:''' demand ischemia |
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| + | *'''Type 3:''' likely MI but patient died before biomarkers were drawn |
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| + | *'''Type 4''' |
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| + | **'''Type 4a:''' PCI-related MI |
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| + | **'''Type 4b:''' stent thrombosis |
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| + | *'''Type 5:''' CABG-related MI |
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| + | ===Etiology=== |
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| − | * Thrombosis: rupture of atherosclerotic plaque resulting in thrombus formation that occludes the lumen |
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| − | * Stenosis: luminal narrowing from progressive atherosclerotic disease |
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| + | *Thrombosis: rupture of atherosclerotic plaque resulting in thrombus formation that occludes the lumen |
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| − | == Clinical Manifestations == |
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| + | *Stenosis: luminal narrowing from progressive atherosclerotic disease |
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| + | ==Clinical Manifestations== |
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| − | * History |
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| − | * Signs & Symptoms |
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| − | * RV infarct will present with |
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| − | ** Hypotension |
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| − | ** Right heart failure |
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| + | *Angina |
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| − | == Investigations == |
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| + | *RV infarct will present with |
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| + | **[[Hypotension]] |
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| + | **Right heart failure |
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| + | === Complications === |
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| − | * EKG |
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| − | ** If concern for inferior STEMI, get a 15-lead to rule out RV infarct |
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| − | * Labs |
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| − | ** Troponin |
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| − | ** CK |
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| − | ** AST |
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| − | * Imaging |
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| − | ** Coronary angiogram |
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| − | ** Myocardial perfusion (MIBI) |
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| + | *[[Cardiogenic shock]] |
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| − | == Management == |
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| + | *LV aneurysm: clot, [[ventricular fibrillation]], [[ventricular tachycardia]] |
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| + | *Ischemic [[mitral regurgitation]] |
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| + | *Dynamic outflow obstruction |
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| + | *Rupture: early (<24h) or late (<7d) |
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| + | **Posterior papillary rupture |
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| + | ***No murmur, but acutely looks very unwell with large V-wave |
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| + | ***Needs urgent MVR |
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| + | *VSD |
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| + | *Free wall rupture: tamponade or PEA |
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| + | ==Investigations== |
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| − | * TNK 0.53mg/kg IV bolus then transfer to PCI centre |
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| − | * If RV infarct |
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| − | ** Fluids and fluids |
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| − | ** Consider inotropes |
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| + | *EKG |
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| − | == Complications == |
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| + | **If concern for inferior STEMI, get a 15-lead to rule out RV infarct |
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| + | *Labs |
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| + | **Troponin |
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| + | **CK |
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| + | **AST |
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| + | *Imaging |
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| + | **Coronary angiogram |
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| + | **Myocardial perfusion (MIBI) |
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| + | ==Management== |
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| − | * Cardiogenic shock |
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| + | |||
| − | * LV aneurysm: clot, VF, VT |
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| + | *TNK 0.53mg/kg IV bolus then transfer to PCI centre |
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| − | * Ischemic mitral regurgitation |
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| + | *If RV infarct |
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| − | * Dynamic outflow obstruction |
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| + | **Fluids and fluids |
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| − | * Rupture: early (<24h) or late (<7d) |
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| + | **Consider inotropes |
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| − | ** Posterior papillary rupture |
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| − | *** No murmur, but acutely looks very unwell with large V-wave |
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| − | *** Needs urgent MVR |
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| − | * VSD |
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| − | * Free wall rupture: tamponade or PEA |
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[[Category:Cardiology]] |
[[Category:Cardiology]] |
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Latest revision as of 08:22, 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
- Unstable angina: no biochemical or EKG abnormalities, but increasing anginal symptoms
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
- Posterior papillary rupture
- 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
