X

Download Acute Coronary Syndrome-Department of Medicine PowerPoint Presentation


Login   OR  Register
X

Share page



  Preview

               
Home / Health & Wellness / Health & Wellness Presentations / Acute Coronary Syndrome-Department of Medicine PowerPoint Presentation

Acute Coronary Syndrome-Department of Medicine PowerPoint Presentation

onlinesearch By : onlinesearch

On : Mar 14, 2014

In : Health & Wellness

Embed :
1047
views

0
downloads
Login / Signup - with account for


  • → Make favorite
  • → Flag as inappropriate
  • → Download Presentation
  • → Share Presentation
  • Slide 1 - Acute Coronary Syndrome MINI LECTURE Kelvin Nguyen
  • Slide 2 - OBJECTIVES Definition of ACS UA, NSTEMI, and STEMI Risk stratification in NSTEMI Management
  • Slide 3 - Acute Coronary Syndrome Definition: a constellation of symptoms related to obstruction of coronary arteries with chest pain being the most common symptom in addition to nausea, vomiting, diaphoresis etc. Chest pain concerned for ACS is often radiating to the left arm or angle of the jaw, pressure-like in character, and associated with nausea and sweating. Chest pain is often categorized into typical and atypical angina.
  • Slide 4 - Acute coronary syndrome Based on ECG and cardiac enzymes, ACS is classified into: STEMI: ST elevation, elevated cardiac enzymes NSTEMI: ST depression, T-wave inversion, elevated cardiac enzymes Unstable Angina: Non specific EKG changes, normal cardiac enzymes
  • Slide 5 - Unstable Angina Occurs at rest and prolonged, usually lasting >20 minutes New onset angina that limits activity Increasing angina: Pain that occurs more frequently, lasts longer periods or is increasingly limiting the patients activity
  • Slide 6 - EKG STEMI: Q waves , ST elevations, hyper acute T waves; followed by T wave inversions. Clinically significant ST segment elevations: > than 1 mm (0.1 mV) in at least two anatomical contiguous leads or 2 mm (0.2 mV) in two contiguous precordial leads (V2 and V3) Note: LBBB and pacemakers can interfere with diagnosis of MI on EKG
  • Slide 7 - EKG NSTEMI: ST depressions (0.5 mm at least) or T wave inversions ( 1.0 mm at least) without Q waves in 2 contiguous leads with prominent R wave or R/S ratio >1. Isolated T wave inversions: can correlate with increased risk for MI may represent Wellen’s syndrome: critical LAD stenosis >2mm inversions in anterior precordial leads Unstable Angina: May present with nonspecific or transient ST segment depressions or elevations
  • Slide 8 - Cardiac Enzymes Troponin is primarily used for diagnosing MI because it has good sensitivity and specificity. CK-MB is more useful in certain situations such as post reperfusion MI or if troponin test is not available Other conditions can cause elevation in troponin such as renal failure or heart failure The increasing troponin trend is the important thing to look for in diagnosing MI. Order Troponin together with ECG when doing serial testing to rule out ACS.
  • Slide 9 - Risk Stratification: TIMI score NSTEMI or unstable angina are risk stratified: Age>=65 >= 3 CAD risk factors: HTN, hyperlipidemia, diabetes, smoker, family hx of early MI Documented CAD with >=50% stenosis ST segment deviation ≥ 2 aginal episodes in past 24 hours Aspirin use in the past week (marker for more severe case) Elevation of cardiac enzymes Stratify risk based on number of variables Risk: 0-2: Low 3-4: Intermediate 5-7: High risk
  • Slide 10 - NSTEMI & Unstable Angina Management NSTEMI or EKG changes suggest ischemia with high risk: Telemetry Aspirin Beta blocker Nitrates Heparin (UFH or LMWH) ACE-I/ARB Statin Consider GP IIb/IIIa inhibitor and clopidogrel EKG normal or non-specific changes with intermediate or low risk: Telemetry Rule out ACS with 3 sets of troponin, EKG Consider pre-discharge stress test
  • Slide 11 - STEMI Management STEMI patients usually go straight to the cath lab from the ED. Goal: door to balloon 90 minutes. Initial management for STEMI: Cardiac monitor Supplemental O2 Nitrates* Beta blocker Morphine Clopidogrel Aspirin Good IV access Call cardiology fellow!
  • Slide 12 - Case 60 year old male with history of DM2 for 20 years, HTN, HLD who presented to the ED with 4 hour onset of chest pain which was described as in the anterior chest without radiation. The pain seemed to improve when he sits down and worsening when he walked upstairs. VS: T 36.9, HR: 95, BP: 84/56, RR 22, O2 sat. 99% RA. ECGs are shown as followed
  • Slide 13 - ppt slide no 13 content not found
  • Slide 14 - ppt slide no 14 content not found
  • Slide 15 - What will you do? What’s your diagnosis? What should be done now?
  • Slide 16 - References 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2005;112:IV-89-IV-110 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013, epublished April 29th 2013 and print published june 4th 2013. Herman LK, et al. Comparison of frequency of inducible myocardial ischemia in patients presenting to emergency department with typical versus atypical or nonanginal chest pain. Am J Cardiol. 2010 105:1561-4. www.uptodate.com: Overview of the acute management of unstable angina and acute non-ST elevation myocardial infarction Initial evaluation and management of suspected acute coronary syndrome in the emergency department Criteria for the diagnosis of acute myocardial infarction
Domino Free PowerPoint Template

Domino

Views : 603

Gym Free PowerPoint Template

Gym

Views : 574

Happy Birthday Free PowerPoint Template

Happy Birthday

Views : 640

Image Sharing Free PowerPoint Template

Image Sharing

Views : 484

Wedding Cake Free PowerPoint Template

Wedding Cake

Views : 845

Puzzle Free PowerPoint Template

Puzzle

Views : 329

Sperm Free PowerPoint Template

Sperm

Views : 876

Parents Free PowerPoint Template

Parents

Views : 442

Airplane Free PowerPoint Template

Airplane

Views : 438

Anniversary Free PowerPoint Template

Anniversary

Views : 614

ECG Heart Beat Free PowerPoint Template

ECG Heart Beat

Views : 1721

Firefighters Free PowerPoint Template

Firefighters

Views : 1323

Piano Free PowerPoint Template

Piano

Views : 628

Question Mark Free PowerPoint Template

Question Mark

Views : 526

Germ Free PowerPoint Template

Germ

Views : 833

Maple Leaf Free PowerPoint Template

Maple Leaf

Views : 507

Back to School Free PowerPoint Template

Back to School

Views : 542

Unity Free PowerPoint Template

Unity

Views : 568

Smoker Free PowerPoint Template

Smoker

Views : 522

Orthodontist Free PowerPoint Template

Orthodontist

Views : 500

Description : Available Acute Coronary Syndrome-Department of Medicine powerpoint presentation for free download which is uploaded by search an active user in belonging ppt presentation Health & Wellness category.

Tags : Acute Coronary Syndrome-Department of Medicine

Shortcode : Get Shareable link