Beruflich Dokumente
Kultur Dokumente
SYNDROME
By: Dr. Muhammad Alauddin Sarwar
Medical officer,
Sindh Government Qatar Hospital,
Karachi.
ACS
Any constellation of clinical symptoms that are
compatible with myocardial ischemia. It encompasses
Acute ST elevated myocardial infarction (STEMI)
Non ST elevated myocardial infarction ( NSTEMI)
Unstable Angina
Worldwide Statistics
Each year:
• > 4 million patients are admitted with unstable
angina and acute MI
• > 900,000 patients undergo PTCA with or without
stent
History
ECG
Cardiac (Bio Markers)
DIAGNOSIS OF ACS
1) HISTORY
Likelihood of ACS Unlikelihood of ACS
Chest or left arm pain as chief Pleuritic pain
symptom. Localized middle or lower
K/C of CAD, including MI abdominal pain.
Age >70 yrs Pain that may be localized by
Male sex the tip of 1 finger.
D/M Pain with movement or
Recent cocaine use palpation of chest wall.
Transient MR, hypotension, Constant chest pain for many
diaphoresis, pulmonary edema. hours
Very brief episodes of pain that
last a few seconds or less.
Pain that radiates into the lower
extremities.
STRATEGIES
In the early conservative strategy, coronary
angiography is reserved for patients with evidence of
recurrent ischemia (angina or ST-segment changes at
rest or with minimal activity) or a strongly positive
stress test despite vigorous medical therapy.
ST-segment Elevation
= 4.5 mm
12-Lead ECG Variations
in AMI and Angina
Baseline
ECG at
11/2/08
5 days before
admission
NSR, ST elevation
II, III and avF.
ST depression in I,
avL and V2 – V6
NSR,Poor R waves
and T inversion II,
III and avF.
Upper} NSR, ST elevation in I, avL, V2 – V5, ST depression in II,III and avF
ANTERIOR WALL MI
NSR,ST elevation in I, avL
and V1 to V6
ST depression in II, III & avF.
Anterior Wall MI
NSR, ST depression V1 to V3 with R wave and upright T
waves, ST elevation in V5 & V6.
Postero Lateral wall MI.
ER Management of STEMI
Reassurance
Targeted history
ECG to be interpreted within 10 min
Oxygen @ 2-4 L/min
I/V access with two wide bore cannulae
ASA (Disprin) 300mg chewable
Clopidogrel (Loclog 75mg) 4 stat+LMWH S/C if
Thrombolytic therapy is not near.