> 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)
