acute coronary syndromes in west hertfordshire masood khan
TRANSCRIPT
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Acute Coronary Syndromes in West Hertfordshire
Masood Khan
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Cardiology Connect Meeting 16 June 2010
Chronology of Atherosclerotic Vascular Disease
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Cardiology Connect Meeting 16 June 2010
AntithromboticTherapy
Stable Angina
UnstableAngina
Non–Q-wave MI
ThrombolysisPrimary PCI
Q-wave MI
Minutes-hours
Days-weeks
STEMINSTEMIAtherothrombosisNew term
Old term
PlaqueRupture
Current terminology in ACS
Normal cardiac enzymes Elevated cardiac enzymes
Unstable Angina
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Cardiology Connect Meeting 16 June 2010
Outcomes: Admission to 6 Months
12
3
17
13
3
20 20
1.5
8
0
10
20
30
Death Stroke Urgent readmission forcardiac event
Pa
tie
nts
(%
)
STEMI (2075)NSTEMI (1856)UA (2883)
Global Registry of Acute Coronary Events
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Cardiology Connect Meeting 16 June 2010
Treatment of ACS
STEMI
Immediate PCI
NSTEMI
Early PCI
UA
Non-invasive or PCI
Risk assessment
Lifestyle changes and secondary prevention
Chest pain
Early suspicion and diagnosis
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Cardiology Connect Meeting 16 June 2010
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Cardiology Connect Meeting 16 June 2010
ACS pain Pain in chest, arms,
back or jaw >15 min
Associated with:Nausea/vomitingBreathlessnessSweating
Do not assess symptoms differently
ethnic groups, or
gender
Do not use response to GTN to make diagnosis
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Cardiology Connect Meeting 16 June 2010
ACS hospital referral
Currently in pain,
or Pain free, but pain in
last 12 hours and ECG abnormal or unavailable
Same day:
Chest pain within 12 hours, butNow pain free, andECG normal
or
Chest pain 12-72 hours
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Cardiology Connect Meeting 16 June 2010
ACS – start management immediately!
Chest pain
Pain relief GTN Opiate
Aspirin 300mg
Pulse oximetery O2 if SpO2 < 94%
12 lead ECG STE or LBBB? ACS not excluded if ECG normal
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Cardiology Connect Meeting 16 June 2010
Secondary prevention
Secondary prevention
Aspirin 75 mg od Dyspepsia: + low dose PPI Healed Ulcer: + high dose PPI
Β-blocker
Clopidogrel 7mg od for 1 yr
ACE inhib orA2 antag
Statin dose and drug controversial
Aldosterone antag.If present in heart failure
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Cardiology Connect Meeting 16 June 2010
ACS in W Herts 2 consultant cardiology ward rounds each
week day, 1 each Sat & Sun All cardiology patients & referrals
Appropriate management decisions Timely discharge
Cardiac catheter lab available 5 days/week Dedicated slots for in patients
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Cardiology Connect Meeting 16 June 2010
ACS in W Herts
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1 2 3 4 5 6 7 WGH
Trust
Da
ys
Adx to ref. Ref. to lab
Data from NW London IHT
603 inpatient referrals to WGH cathlab in 2009
0
NICE target <96 hrs
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Cardiology Connect Meeting 16 June 2010
West Herts. Heart Attack Centre
Nationaltarget
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Cardiology Connect Meeting 16 June 2010
ACS in W Herts Currently auditing appropriateness of
discharge medication
100% referral to cardiac rehabilitation
All patients undergoing PCI offered follow up in cardiology clinic follow up time should be shorter
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Thank you