Acute Coronary Syndrome

Acute Coronary Syndrome
By:Rich Derby, Lt Col, USAF
MGMC Family Practice Program

Objectives

* Define & delineate acute coronary syndrome
* Review Management Guidelines
* Review secondary prevention initiatives

Scope of Problem
Expanding Risk Factors
* Smoking
* Hypertension
* Diabetes Mellitus
* Dyslipidemia
* Family History—event in first degree relative >55 male/65 female
* Age-- > 45 for male/55 for female
* Chronic Kidney Disease
* Lack of regular physical activity
* Obesity
* Lack of Etoh intake
* Lack of diet rich in fruit, veggies, fiber

Acute Coronary Syndromes
Similar pathophysiology
Similar presentation and early management rules
STEMI requires evaluation for acute reperfusion intervention
* Unstable Angina
* Non-ST-Segment Elevation MI
* ST-Segment Elevation MI

Diagnosis of Acute MI
STEMI / NSTEMI
Diagnosis of Angina
* Typical angina
* Atypical angina
* Noncardiac chest pain

Diagnosis of Unstable Angina
* Patients with typical angina - An episode of angina
* Patients not known to have typical angina
Unstable Angina
Acute Management
Evaluation
Time Sensitive
Chest pain suggestive of ischemia
Immediate assessment within 10 Minutes
Initial labs and tests
Emergent care
History & Physical
Focused History
Targeted Physical
ECG assessment
Normal or non-diagnostic EKG3
Cardiac markers
Prognosis with Troponin
Mortality at 42 Days
Risk Stratification
Cardiac Care Goals
STEMI cardiac care
Fibrinolysis indications
Absolute contraindications for fibrinolysis therapy in patients with acute STEMI
Relative contraindications for fibrinolysis therapy in patients with acute STEMI
STEMI cardiac care
Comparing outcomes
Medical Therapy
Additional medication therapy
STEMI care CCU
Unstable angina/NSTEMI cardiac care
Probable ischemic symptoms
TIMI Risk Score
ACS risk criteria
Moderate to high likelihood of CAD
High Risk ACS
Invasive therapy option UA/NSTEMI
Conservative Therapy for UA/NSTEMI
Secondary prevention behavioral intervention
Secondary prevention cognitive
Medication Checklist after ACS
Summary

Acute Coronary Syndrome.ppt