Acute coronary syndrome (main): Difference between revisions

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#[[Non ST-Elevation Myocardial Infarction (NSTEMI)]] (25%)
#[[Non ST-Elevation Myocardial Infarction (NSTEMI)]] (25%)
#[[Unstable Angina]] (38%)
#[[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 ==
== DDx ==

Revision as of 20:04, 8 February 2014

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%)

DDx

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


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

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