ACUTE CORONARY SYNDROME

CARDIOVASCULAR MEDICAL STAFF

DR. H. Chasan Boesoirie Genereal Hospital
 Acute Coronary Syndrome (ACS)
• Spectrum of clinical presentations ranging from
those for ST-segment elevation myocardial
infarction (STEMI) to presentations found in non–
ST-segment elevation myocardial infarction
(NSTEMI/ NSTE-ACS) or in unstable angina.
• It is almost always associated with rupture of an
atherosclerotic plaque and partial or complete
thrombosis of the infarct-related artery.
 Signs & Symptoms
• Palpitations
• Pain, which is usually described as pressure, squeezing, or a
burning sensation across the precordium and may radiate to
the neck, shoulder, jaw, back, upper abdomen, or either arm
• Exertional dyspnea that resolves with nitrate or rest
• Diaphoresis from sympathetic discharge
• Nausea from vagal stimulation
• Decreased exercise tolerance
 6E.. Precipitating Factors
• Exposure cold
• Eating
• Emotion
• Exercise
• Early in the day
• Ejaculation
 Physical findings
• Hypotension
• Jugular venous distention
• Cool, clammy skin and diaphoresis in patients
with cardiogenic shock
• Gallop S3 dan S4
• Rales on pulmonary examination
 Diagnosis
• History taking
• Physical exams
• ECG
• CXR
• Cardiac markers
• Echocardiography
3 components for diagnosis of ACS
• Chest pain (typical)
• ECG: ST - T changes
• Elevated cardiac markers (Trop T/I, CKMB)
 Management
Initial therapy focuses on the following:
• Stabilizing the patient’s condition
• Relieving ischemic pain
• Providing antithrombotic therapy
Stabilizing the patient’s condition
• O2 therapy (SpO2 <94)
• IV access
Pharmacologic anti-thrombotic therapy 
• Aspirin
• Clopidogrel/ Ticagrelor
 Pharmacologic anti-ischemic therapy 
• Nitrates (for symptomatic relief)
• Beta blockers: These are indicated in all
patients unless contraindicated
 M-O-N-A-Co
• Morphine (not as first line)
• Oxygen
• Nitrate
• Aspirin
• Clopidogrel/Ticagleror
What next?
Refer to Specialist a.s.a.p!
THANK YOU
Quiz
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