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ACUTE CORONARY SYNDROMES maleek
ACUTE CORONARY SYNDROMES maleek
BY
ABDUL MALEEK MORO (kunaama MD)
OUTLINE/OBJECTIVES
• DEFINITIONOF ACS
• BRIEF ANATOMY OF THE CORONARY CIRCULATION
• CAUSE/PATHOPHYSIOLOGY
• RISK FACTORS
• CLINICAL PRESENTATIONS
• DIAGNOSIS/DIFFERENTIATION
• MGT
• COMPLICATIONS
• CASE PRESENTATION
•
DEFINITION OF ACS
• Stable angina?
•
Brief anatomy of the coronary circulation
Sub types
• Unstable angina:
• An unprovoked or prolonged episode of chest pain raising suspicion of acute myocardial infarction (AMI)
• Without definite ECG or laboratory evidence
• NSTEMI:
• Chest pain suggestive of AMI
• Non-specific ECG changes (ST depression/T inversion/normal)
• Laboratory tests showing release of troponins
• STEMI:
• Sustained chest pain suggestive of AMI
• Acute ST elevation or new LBBB
causes
• Atherosclerosis • Non-Atherosclerotic
• 1. Congenital anomalies
• Epithelial injury
• Migration of
monocytes/macropha
ges
• LDL lipids consumed
foam cells
• Growth factors
smooth muscle,
collagen,
proteoglycans
• Atheromatous plaque
forms
RISK FACTORS
• Modifiable • Non-modifiable
• Smoking • Increasing age
• Obesity • Gender (male )(after menopause
• Diet , risk is virtually same in both
genders)
• Sedentry life
• Ethnicity
• Dyslipidemia
• Family history
• Hpt
• Dm
• Dm
PRESENTATION
• HISTORY
The cardinal symptom Is CHEST PAIN
• http://www.thrombosisadviser.com/html/images/library/atherothrombosis/stemi-and-nstemi-ecg-illustration-PU.jpg
NSTEMI
• There is partial occlusion of a major vessel or complete occlusion of a
minor vessel
NSTE-ACS STEMI
(Non ST-Elevation ACS) (ST elevation MI)
cardiac markers
negative positive
• “Time is muscle”