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Acute Coronary Syndrome – Stable Angina Management
Australian Prescriber VOLUME 38 : NUMBER 4 : AUGUST 2015 Diagnosis: Risk Stratification: Clinical Evaluation: Stress Testing: Imaging of Coronary Arteries: Lifestyle Modification: Prevention of Cardiovascular Events: Drug Indications Mechanism Adverse effects Precautions Nitrates (short- and long-acting) Relief of acute or anticipated pain (short-acting)Prevention of angina (long-acting) Systemic and coronary…
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Acute Coronary Syndrome – long term management
Goal: Recommendations Smoking Complete cessation No exposure to environmental/ passive tobacco smoke – ceasing ↓ %Y mortality by half– Patients should be asked about tobacco use status at every office visit– Consider pharmacotherapy for patients smoking >10 cigarettes per day: Nicotine replacement therapy (NRT) — is the first line choice of…
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Acute Coronary Syndrome – Complications
Complications Post-AMI First 2-3 Days: Later Complications: Other Late Complications: Pain Management Left Ventricular Failure Cardiogenic Shock Right Ventricular Infarction Pericarditis Arrhythmias Thromboembolic Disease Cardiac Rupture Ventricular Aneurysm Dressler’s Syndrome Valvular Heart Disease
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Acute Coronary Syndrome – STEMI
Definition: clinical sx consistent w ACS w ECG features including any of: Reperfusion Critera: Qwaves Area of Infarction Type of Infarct ECG Leads Reciprocal ECG Changes Heart Territory Coronary Vessel Inferior Infarct II, III, aVF I, aVL Inferior wall of the left ventricle Right Coronary Artery (RCA) or Left Circumflex…
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Acute Coronary Syndrome – NSTEMI
Most pt’s will present with prolonged or recurrent central chest discomfort but others (elderly, DM, women) may present with atypical sx. Risk = DM & stress Most pt’s with NSTEMI are normal on PE. An abnormal ECG, esp dynamic ST-segment deviation (≥0.5mm) or new T-wave inversion (≥2mm) will confirm the…
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Cardiac Investigations
Troponins High-sensitive Troponin (hs-Trop T and hs-Trop I) Purpose: Kinetics: Advantages: Disadvantages: Causes of Elevated Troponin in Absence of Acute Coronary Syndrome (ACS): Clinical Practice: Troponin Test Indications in General Practice: Important Considerations: Pitfalls in General Practice: Additional Considerations: Rapid and substantial increases in hs-trop T enhance the likelihood of…
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Acute Coronary Syndrome
Differential Diagnosis PAIN Onset: PAIN Characteristic Provocative Factors definitions NEW YORK HEART ASSOCIATION FUNCTIONAL CLASSIFICATION OF ANGINA Class 1 Patients with cardiac disease but without resulting limitation of physical activity.Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. Class II Patients with cardiac disease resulting in…
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Chest pain in GP land
Causes of chest pains presenting in general practice, compared with emergency departments Percentage in general practice (%) Percentage in emergency departments (%) Musculoskeletal conditions 29 7 Respiratory conditions,including pneumonia,pneumothorax and lung cancer 20 12 Psychosocial conditions 17 9 Serious cardiovascular conditions, including myocardial infarction, unstable angina, pulmonary embolism and heart…