ACUTE CORONARY SYNDORME Mostafa alshamiri January 2013

Definitions – Acute coronary syndrome Any constellation of clinical symptoms that are compatible with acute myocardial ischemia. It encompasses a spectrum from AMI  to  UA

A- myoglobin/CK-MB isoforms after AMI B – Cardiac Troponin after AMI C - CK-MB after AMI D – Cardiac Troponin after UA

11 Hospitalizations in the U.S. Due to Acute Coronary Syndromes (ACS) Acute Coronary Syndromes* 1.57 Million Hospital Admissions - ACS UA/NSTEMI † STEMI 1.24 million Admissions per year 0.33 million Admissions per year Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115: *Primary and secondary diagnoses. †About 0.57 million NSTEMI and 0.67 million UA.

Killip classification Cardiology A system used to stratify the severity of left ventricular dysfunction and determine clinical status of Pts post MI : Class 1 No rales, no 3 rd heart sound Class 2 Rales in < 1 ⁄ 2 lung field or presence of a 3 rd heart sound Class 3 Rales in > 1 ⁄ 2 lung field–pulmonary edema Class 4 Cardiogenic shock–determined clinically

STEMI

NSTEMI

Treatment of ACS ASA Clopedogril Heparine Reperfusion lytic or PPCI for STEMI Glycoprotein IIB-IIIA receptor antagonist (NSTEMI) Statins BB ACEI or ARBs Symptomatic treatment MONA

Summary High risk patients – 1.7% risk of death after 30 days Intermediate patients – 1.2% risk of death after 30 days Low risk patients – no death after 30 days