Acute Coronary Syndrome

Posted by e-Medical PPT
Worldwide Statistics
> 4 million patients are admited with unstable angina and actue MI
> 900,000 patients undergo PTCA with or without stent

Myocardial Ischemia
Spectrum of presentation
Silent ischemia
Exertion-induced angina
Unstable angina
Acute myocardial infarction  

Patients are categorized into 3 groups
Non- cardiac chest pain
Unstable angina
Myocardial infarction

Acute Coronary Syndrome
The spectrum of clinical conditions ranging from:
 Unstable angina
 Non-Q wave MI
 Q-wave MI
Characterized by the common pathophysiology of a disrupted atheroslerotic plaque
Angina at rest (> 20 minutes)
New-onset (<2 months) exertional angina (at least CCSC III in severity)
Recent (< 2 months) acceleration of angina ( increase in severity of at least one CCSC class to at least CCSC class III)

Unstable Angina precipitating factors
Inappropriate tachycardia
 Anemia,fever,hypoxia,tachyarrhythmias,thyrotoxicosis
High afterload
 Aortic valve stenosis,LVH
High preload
 High cardiac output, chamber dilatation
Inotropic state
 Sympathomimetic drugs,cocaine intoxication

Unstable Angina prognostic indicators
Presence of ST-Twave changes with pain
Hemodynamic deterioration
 Pulmonary edema, new mitral regurgitation
 3rd heart sound, hypotension
Other predictors
 Left ventricular dysfunstion extensive CAD, age, comorbid conditions(diabetes mellitus, obstructive pulmonary disease, renal failure, malignancy)

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