Download - Acute Coronary Syndrome. Quick guide 2013
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Cardiovascular Association ASCARDIO-VenezuelaEuropean Society of Cardiology
Acute Cardiovascular Care Association
Acute Coronary SyndromeQuick Guide
Francisco J. Chacón-LozsánMD student UCLA-Venezuela
European Society of Cardiology: Acute Cardiovascular Care Association
LinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco
2013
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Criteria for acute myocardial infarction
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Criteria for prior myocardial infarction
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Types
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Pain Differentiation
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Pain Scores
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HEART score
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ECG Diagnosis
Normal
Ischemia—Tall T Wave or inverted (infarction),ST segment depressed (angina)
Damage— elevated ST segment, T wave inverted.
Infraction (Acute)—Pathologic Q wave,elevated ST segment and T wave inverted.
Infarction (previous)—Pathologic Q wave,ST-T can be normal.
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ECG Diagnosis
J Point
In 2 contiguous leads must have:≥ 0,25 mV in males <40 years old.≥ 0,2 mV in males >40 years old.≥ 0,15 mV females in leads V2-V3≥ 0,1 mV other leads (in absence of left ventricular hypertrophy or LBBB)
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ECG Diagnosis
Ischemia Q
wave
Ischemia Q wave must have:More of 0,04sec of duration.More of 25% or R wave of amplitude.
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ECG DiagnosisIschemia localization
I lateral aVR V1 septal V4 anterior
II Inferior aVL lateral
V2 septal V5 lateral
III inferior aVF inferior
V3 anterior V6 lateral
Derivation Affected Region
Coronary Lesion
V1, V2, V3 Antero-Septal Anterior Descendent
V3, V4 Anterior Anterior Descendent
V5, V6 Lower Lateral Circumflex, Right Coronary
DI, aVL Upper Lateral Diagonal, Circumflex
DII, DIII, aVF Inferior Right Coronary, Circumflex
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ECG diagnosis
subendocardyum
subepicardyum
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Biomarkers
Hours Days
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UNSTEMI’s Management
Relieve angina using Nitrates.Patients using BB must continues using it if not Killip class >IIIUse BB in pateints with EF preserved.Calcium channel blockers are indicated in patients with nitrates and BB to relief symptoms.Use double antiplatelet theraphy:
• If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned Heparin 70U/Kg EV + Atorvastatin 80mg.
• To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned Heparin 60U/kg EV + Atorvastatin 80mg.
Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV.If not: streptokinase: 1500.000U EV in 1hr.
What to do?
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Criteria for high risk with indication for invasive management
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A, indicates appropriate; CTO, chronic total occlusion; I, inappropriate; Int., intervention; Med., medical; Prox. LAD, proximal left anterior descending artery; Rx, treatment; U, uncertain; and vz., vessel
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What to do?
STEMI’s Management
Star the chronometer.Calm pain: consider Opioids.Reduce anxiety: consider Tranquilizer in very anxious patients.Use oxygen in patients with SaO2<95%, breathlessness or with acute heart failure.Use double antiplatelet theraphy:
• If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned Heparin 70U/Kg EV + Atorvastatin 80mg.
• To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned Heparin 60U/kg EV + Atorvastatin 80mg.
Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV.If not: streptokinase: 1500.000U EV in 1hr.
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Don’t forget the chronometer!!!
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References
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Thanks…