acsx presentation and management
DESCRIPTION
ACSx presentation and management. A.Abdi,M.D. Initial Diagnosis. Symptoms ECG Cardiac Biomarkers. CHARACTERISTICS OF TYPICAL ANGINAL CHEST PAIN (ADAPTED FROM ROSEN’S, EMERGENCY MEDICINE). Assessing Likelihood of ACS. Cardiac Biomarkers. Risk Stratification. Based on initial - PowerPoint PPT PresentationTRANSCRIPT
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A.Abdi,M.D
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Initial DiagnosisSymptomsECGCardiac Biomarkers
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CHARACTERISTICS OF TYPICAL ANGINAL CHEST PAIN (ADAPTED FROM ROSEN’S, EMERGENCY MEDICINE)
CHARACTERISTICSUGGESTIVE OF ANGINALESS SUGGESTIVE OF ANGINA
TYPE OF PAINDULL PRESSURE/CRUSHING PAIN
SHARP/STABBING
DURATION2-5 MIN, <20 MINSECONDSTO HOURS/CONTINUOUS
ONSETGRADUALRAPID
LOCATION/CHEST WALL TENDERNESS
SUBSTERNAL, NOT TENDER TO PALP.
LATERAL CHEST WALL/TENDER TO PALP.
REPRODUCIBALITYWITH EXERTION/ACTIVITY
WITH BREATHING/MOVING
AUTONOMIC SYMPTOMSPRESENT USUALLYABSENT
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Assessing Likelihood of ACSHigh LikelihoodIntermediate
LikelihoodLow Likelihood
•Chest or left arm discomfort similar to prior angina
•Transient murmur, hypotension, or heart failure
•New ST changes
•Elevated Enzymes
•Chest or left arm as primary symptom
•Age > 70
•Male gender
•Diabetes
•Known Vascular Dz.
•Q-waves on ECG
•No enzyme elevation
•Suggestive symptoms
•Recent cocaine
•Pain reproducible with palpation
•Minimal ECG changes
•Normal ECG
•No enzyme elevation
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Cardiac Biomarkers
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Risk Stratification
UA or NSTEMI- Evaluate for Invasive vs. conservative treatment
- Directed medical therapy
Based on initialBased on initialEvaluation, ECG, andEvaluation, ECG, and
Cardiac markersCardiac markers
- Assess for - Assess for reperfusionreperfusion
- Select & - Select & implement implement reperfusion reperfusion therapytherapy
- Directed medical - Directed medical therapytherapy
STEMI Patient?
YESYES NONO
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51-year-old male with bicuspid aortic valve, aortic insufficiency and hypertension who had an episode of chest pain 2 days prior to this tracing.
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The patient is an elderly female with a known history of left bundle branch block who presented to the emergency ward with shortness of breath
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A 52-year-old man. What is his chief complaint? What is the rhythm disturbance?
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A 43-year-old man diagnosed with lateral subendocardial ischemia based on ST depressions in
aVL. Do you agree?
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A 47-yr-old man with double trouble
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A 41-yr-old man with chest discomfort. What is the most likely diagnosis?
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Subtle syncopation. 54-year-old morbidly obese male with an acute inferior MI. What is the rhythm?
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64-year-old male with chest pain.
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89-year-old man with a history of severe congestive heart failure. What is the rhythm? What is the possible
significance of rsR' in V6?
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What is the ECG diagnosis in this recording with baseline movement?
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54-year-old man with rest chest pain
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Middle-aged man with chest pain after a motor vehicle accident with blunt trauma to the chest. The ECG is diagnostic of which condition
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70 year old woman with ECG showing which of the following major diagnoses?