X

Download Acute Coronary Syndromes PowerPoint Presentation

SlidesFinder-Advertising-Design.jpg

Login   OR  Register
X


Iframe embed code :



Presentation url :

Home / Health & Wellness / Health & Wellness Presentations / Acute Coronary Syndromes PowerPoint Presentation

Acute Coronary Syndromes PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

PowerPoint is the world's most popular presentation software which can let you create professional Acute Coronary Syndromes powerpoint presentation easily and in no time. This helps you give your presentation on Acute Coronary Syndromes in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this Acute Coronary Syndromes powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by slidesfinder in Health & Wellness ppt presentation category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

About This Presentation

Slide 1 - Acute Coronary Syndromes Robert Smith August 4, 2003
Slide 2 - Definitions Acute coronary syndrome is defined as myocardial ischemia due to myocardial infarction (NSTEMI or STEMI) or unstable angina Unstable angina is defined as angina at rest, new onset exertional angina (<2 months), recent acceleration of angina (<2 months), or post revascularization angina
Slide 3 - ppt slide no 3 content not found
Slide 4 - Diagnosis Dx of acute coronary syndrome is based on history, physical exam, ECG, cardiac enzymes Patients can then be divided into several groups Non-cardiac chest pain (i.e., Gastrointestinal, musculoskeletal, pulmonary embolus) Stable angina Unstable angina Myocardial infarction (STEMI or NSTEMI) Other cardiac causes of chest pain (i.e., aortic dissection, pericarditis)
Slide 5 - Pre-test Probability In the absence of abnormal findings on physical exam, ECG, or enzymes, the pre-test probability of acute coronary syndrome must be determined by the clinician A good history is crucial (is the chest pain typical or atypical; what are the associated symptoms) Determination of risk factors is also crucial (male, age >55, smoking, DM, HTN, FamHx, hyperlipidemia, known CAD)
Slide 6 - Pathophysiology of ACS Plaque rupture and subsequent formation of thrombus – this can be either occlusive or non-occlusive (STEMI, NSTEMI, USA) Vasospasm such as that seen in Prinzmetal’s angina, cocaine use (STEMI, NSTEMI, USA) Progression of obstructive coronary atherosclerotic disease (USA) In-stent thrombosis (early post PCI) In-stent restenosis (late post PCI Poor surgical technique (post CABG)
Slide 7 - Pathophysiology of ACS Acute coronary syndromes can also be due to secondary causes Thyrotoxicosis Anemia Tachycardia Hypotension Hypoxemia Aterial inflammation (infection, arteritis)
Slide 8 - Treatment of ACS; Aspirin Aspirin is an antiplatelet agent that initiates the irreversible inhibition of cyclooxygenase, thereby preventing platelet production of thromboxane A2 and decreasing platelet aggregation Administration of ASA in ACS reduces cardiac endpoints
Slide 9 - Aspirin Trials VA Cooperative Study Canadian Multicenter Trial RISC Antithrombotic Trialists Collaberation PURSUIT
Slide 10 - ACC/AHA Guidelines for Aspirin Therapy Aspirin should be given in a dose of 75-325 mg/day to all patients with ACS unless there is a contraindication (in which case, clopidogrel should be given)
Slide 11 - Treatment of ACS; Nitrates Nitroglycerin is considered a cornerstone of anti-anginal therapy, despite little objective evidence for its benefit Benefit is thought to occur via reduction in myocardial O2 demand secondary to venodilation induced reduction in preload as well as coronary vasodilation and afterload reduction Titrate to relief of chest pain; chest pain = death of myocardial cells No documented mortality benefit
Slide 12 - Treatment of ACS; Beta Blockers Beta Blockers reduce myocardial oxygen demand by reducing heart rate, contractility, and ventricular wall tension Administration of beta blockers in ACS reduces cardiac endpoints
Slide 13 - Beta Blocker Trials HINT (metoprolol) Beta Blocker Heart Attack Trial (propranolol) Esmolol vs. placebo Carvedilol vs. placebo Propranolol vs. placebo Overall, treatment with beta blockers reduces primary endpoints when compared to placebo
Slide 14 - AHA/ACC Guidelines for Beta Blocker Therapy Intravenous beta blockers should be used initially in all patients (without contraindication) followed by oral beta blockers with the goal being decrease in heart rate to 60 beats per minute A combination of beta blockers and nitrates can be viewed as first line therapy in all patients with ACS
Slide 15 - Treatment of ACS; Heparin Heparin (unfractionated heparin or UFH) has traditionally been the mainstay of therapy in acute coronary syndromes as its efficacy has been documented in several large, randomized trials
Slide 16 - Heparin Trials Heparin/Atenolol Trial The Canadian Heparin/Aspirin Trial The RISC Trial Overall, UFH therapy generally results in an important clinical benefit when compared to placebo. It is more effective when given in continuous infusion rather than intermittent boluses
Slide 17 - Treatment of ACS; LMWH More recent studies indicate that low molecular weight heparin is also effective in the reduction of end points such as myocardial infarction or death Some studies report that LMWH, when used in combination with ASA, may be superior to continuous infusion of Heparin
Slide 18 - LMWH Trials FRISC TIMI IIB ESSENCE INTERACT EVET
Slide 19 - ACC/AHA Guidelines for Heparin Therapy All patients with acute coronary syndromes should be treated with a combination of ASA (325 mg/day) and heparin (bolus followed by continuous infusion with goal of PTT 1-2.5X control) or ASA and low molecular weight heparin unless one of the drugs is contraindicated
Slide 20 - Treatment of ACS; ACE-I The best documented mechanism by which these agents act is to reduce ventricular remodeling over days to weeks after myocardial damage. However, there is data that a mortality benefit exists when these agents are used early in the course of ACS Administration of ACE-I in ACS reduces cardiac endpoints
Slide 21 - ACE-I Trials GISSI-3 (Lisinopril) ISIS-4 (Captopril) SMILE (Zofenipril) FAMIS (Fosinopril) SAVE (Captopril) TRACE (Trandolapril) AIRE (Ramiripril)
Slide 22 - AHA/ACC Guidelines for ACE-I Therapy ACE-I should be administered to all patients in the first 24 hours of ACS provided hypotension and other clear cut contraindications are absent
Slide 23 - Treatment of ACS; Statins Statins may be of benefit in ACS Possible mechanisms include plaque stabilization, reversal of endothelial dysfunction, decreased thrombogenicity, and reduction of inflammation
Slide 24 - Statin Trials MIRACL (modest benefit in cardiac endpoints, no mortality benefit) SYMPHONY (no benefit) There is no AHA/ACC class I indication for use of statin therapy in ACS
Slide 25 - Treatment of ACS; IIBIIIA Inhibitors More potent inhibition of platelet aggregation may be of importance in patients with ACS that is associated with unstable coronary lesion and thrombus formation. This can be achieved by the use of GP IIBIIIA inhibitors Administration of IIBIIIA inhibitors reduces cardiac endpoints
Slide 26 - IIBIIIA Trials PRISM-PLUS (Tirofiban – prior to PCI) EPIC (Abciximab – prior to PCI) CAPTURE (Abciximab – prior to PCI) GUSTO IV-ACS (Abciximab – no PCI) PARAGON (Lamifiban – no PCI) PURSUIT (Eptifibatide -- no PCI) RESTORE (Tirofiban – no PCI)
Slide 27 - AHA/ACC Guidelines for use of IIBIIIA inhibitors A IIBIIIA inhibitor should be administered to all patients in whom a percutaneous intervention is planned (in addition to heparin/ASA) Eptifibatide or Tirofiban should be administered to patients with ACS in whom PCI is not planned if other high risk features are present (TIMI risk score >3)
Slide 28 - TIMI Risk Score Age >65 yrs Daily ASA Therapy (>7 days prior to event) Symptoms of Unstable Angina Documented CAD (stenosis > 50%) 3 or more traditional cardiac risk factors Elevated cardiac enzymes ECG changes
Slide 29 - TIMI Risk Score Score of 3 or less = low risk Score of 4-5 = intermediate risk (use IIBIIIA) Score of 6-7 = high risk (use IIBIIIA)
Slide 30 - Treatment of ACS; Clopidogrel Clopidogrel is a potent antiplatelet agent It should be administered to all patients who cannot take ASA The CURE trial suggests a benefit to adding Clopidogrel to ASA/Heparin in patients going for PCI Give 300 mg loading dose followed by 75 mg/day
Slide 31 - AHA/ACC Guidelines for Clopidogrel Clopidogrel should be administered to patients who cannot take ASA because of hypersensitivity or gastrointestinal intolerance In hospitalized patients in whom an early, noninterventional approach is planned, clopidogrel should be added to ASA as soon as possible on admission and administered for at least 1 month and up to 9 months. Do not use clopidogrel if there is any possibility patient may be candidate for CABG
Slide 32 - Treatment of ACS; Emergent Revascularization In the setting of STEMI primary PCI is associated with better outcomes than thrombolysis Emergent PCI is also indicated in the setting of a new LBBB
Slide 33 - PCI Trials PAMI (PTCA vs. thrombolysis) Netherlands Trials (PTCA vs. thrombolysis) GUSTO IIB (PTCA vs. thrombolysis) DANAMI-2 (stenting vs. thrombolysis) STAT (stenting vs. thrombolysis)
Slide 34 - AHA/ACC Guidelines for Primary PCI Primary PCI is indicated as an alternative to thrombolysis when the following criteria are met: STEMI or new LBBB Can undergo PCI within 12 hours of the onset of symptoms The MD doing the intervention does more than 75 PCI’s/yr The procedure is done in a center that does more than 200 PCI’s/yr and has surgical backup
Slide 35 - Conclusions; Approach to Chest Discomfort Good History and Physical (note time and duration of symptoms) Careful evaluation of ECG (compare to previous when possible) Check Cardiac Enzymes Monitor on Telemetry Oxygen
Slide 36 - Conclusions; Treatment of NSTEMI/USA ASA NTG (consider MSO4 if pain not relieved) Beta Blocker Heparin/LMWH ACE-I +/- Statin +/- Clopidogrel (don’t give if CABG is a possibility) +/- IIBIIIA inhibitors (based on TIMI risk score)
Slide 37 - Conclusions; Treatment of STEMI ASA NTG (consider MSO4 if pain not relieved) Beta Blocker Heparin/LMWH ACE-I +/-Clopidogrel (based on possibility of CABG) IIBIIIA +/- Statin Activate the Cath Lab!!!
 

Frequently Asked Questions

> About SlidesFinder?

Slidesfinder is a website that allows users to upload and share their PowerPoint presentations online. It provides a platform for individuals and businesses to share their ideas and knowledge through presentations, and for others to view and download these presentations for educational or professional purposes.
Slidesfinder offers a wide range of presentation topics and categories, including business, education, science, technology, health, and more. Users can also search for presentations using keywords, tags, or by category. The website provides tools to create professional presentations with rich media, animations, and graphics.



One of the key features of Slidesfinder is its user-friendly interface, which allows users to easily upload, view, and share presentations. Users can also embed their presentations in their websites or blogs using the website's embed code feature.
Slidesfinder also offers premium services, such as the ability to create private presentations and to download presentations in high-quality formats. However, the basic features of Slidesfinder are free to use, making it accessible to anyone who wants to share their ideas and knowledge through presentations.

> How do I register with SlidesFinder?

Go to registration page (you can see signup link on top of website page) https://www.slidesfinder.com/signup . If you have facebook/gmail account them just click on SIGN IN WITH FACEBOOK OR SIGN IN WITH GOOGLE button, by this you will be a registered member of slidesfinder without filling any form, required detail automatically will be fatch from your account. If you do not a Facebook account, then click on "Signup". Fill all required fields and you will be a registered member of slidesfinder.

> Is slidesfinder account confirmation is mandatory?

Yes it is mandetory to active your account to login.

> Do I need to signup/login on SlidesFinder before uploading a PowerPoint presentation?

Yes, you need to login with your account before uploading presentation. Your username will be displayed on your uploaded presentation. Your registered email id is needed for sending your stats of uploaded presentation.

Slidesfinder is a sharing website for PowerPoint presentations search and share. Find your interest in the form of powerpoint presentations on slidesfinder and save your valuable time . On Slidesfinder you get presentations from our huge library of professional ppt presentations. We believe in making your search INFORMATIVE and FUN. Find your best ppt presentation from a pool of PowerPoint presentations stacked under important industry categories like business & management, heath & Wellness,eduction & training etc. We provide unique informative PowerPoint presentation for marketers, presenters and educationists. These professional PowerPoint presentations are uploaded by professionals from across numerous industry segments.These ppt presentations are available for FREE download.

Not just finding your interest, but facilitate you broadcast your interest. We have created this platform for easy sharing of PowerPoint presentations, ensuring that these presentations get maximum exposure. Create your slidesfinder account and upload PowerPoint presentations for free, share on social media platforms and BUILD YOUR CROWD WITH PRESENTATION !!

The Great Buddha says, "Share your knowledge.It’s a way to achieve immortality"! So, start sharing knowledge and we are here to make that immortal !!

© 2013-2022 SlidesFinder. All rights reserved.

Re-productivity of content are not allowed. Without prior written permission from author, commercial use of any content is illegal.