Acute coronary syndrome (main)

Background

ACS is three diseases involving the coronary arteries:

1. ST-Elevation Myocardial Infarction (STEMI) (30%)
2. Non ST-Elevation Myocardial Infarction (NSTEMI) (25%)
3. Unstable Angina (38%)

Types of Myocardial Infarction

Type 1: Ischemic myocardial necrosis due to plaque rupture ( ACS)

Type 2: Ischemic myocardial necrosis due to supply-demand mismatch, e.g. coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias.

Type 3: sudden cardiac death (no cTr values)

Type 4: procedure related, post PCI or stent thrombosis ( cTr > 5X Decision Level).

Type 5 post CABG (cTr > 10X Decision Level).

DDx

• Chest Pain (DDx)
• Troponin (DDx)
• Cocaine Chest Pain
• Abdominal Pain

Diagnosis

Clinical factors that increase likelihood of ACS/AMI:

1. Chest pain radiating both arms >R arm >L arm
2. Chest pain associated with diaphoresis
3. Chest pain associated with N/V
4. Chest pain with exertion

Clinical factors that decrease likelihood of ACS/AMI:

1. Pleuritic chest pain
2. Positional chest pain
3. Sharp, stabbing chest pain
4. Chest pain reproducible with palpation

• ECG (Diagnosis)
  • ECG is normal in 8% of all confirmed MI's
  • In LBBB see Sgarbossa's Criteria
• Cardiac Enzymes
• ACS - Risk Stratification
• ACS - Anatomical Correlation

Treatment

Intensity of Rx should be based on likelihood that sx are due to acute coronary thombosis

1. ST-Elevation Myocardial Infarction (STEMI)
2. Non ST-Elevation Myocardial Infarction (NSTEMI)
3. Unstable Angina

Disposition

• Admit all ACS pts

Prognosis

ACS - Stress Testing

See Also

• ACS - Anatomical Correlation
• ACS - Risk Stratification
• ST-Elevation Myocardial Infarction (STEMI)
• ACS - Stress Testing
• NSTEMI
• Unstable Angina