Acute coronary syndrom:
Spectrum of acute ischemia related syndromes.
Stenosis in the coronary artery or a thrombus maybe present causing partial occlusion of the
artery. Leading to MI (STEMI or NSTEMI)
Stable angina → Unstable angina → STEMI → NSTEMI & all share the same pathophysiology.
Pt at risk of MI
Prinzmetal’s angina → in Female d/t vasospasm of the coronary artery.
Signs & Symptoms :-
Chest pain =angina on exertion (main main symptom)
→ radiates to the left arm commonly but can also go to the right arm.
→crushing or pressure feeling pain
Started as chest pain while exertion then rest the pain resolve
But now it is chest pain even at rest
The dr will start to think 1. He is having coronary stenosis. 2. The stenosis is getting worse.
& the pt may develop from stenosis to complete occlusion.
Diaphoresis → increase sweating
S3 → d/t acute heart failure
SBP <80 mmHg
Pulmonary crackles
Causes :
Stenosis
Plaque rupture
Thrombus
Vasospasm → prinzmetal’s angina
Surgery → during CABG
In stent thrombosis
Investigations :
History
ECG changes
, Cardiac markers
Then after investigations, classify the pt for Diagnosis :
Unstable angina NSTEMI STEMI
Stenosis of the artery Thrombosis is there & a part Complete artery occlusion by
(No thrombus) of the fibrous cap rutured the thrombosis & platelet
causing the platelet to adhere aggregation.
& aggregate. This partially
occlude the artery. So no
changes in heart tissue.
No ECG changes On ECG : On ECG:
ST- depression ST elevation
T-wave inversion LBBB
Normal cardiac enzymes High cardiac enzyme All cardiac enzymes are high.
(troponin levels are high)
CK-MB high
Chest pain while walking. Chest pain even at rest. Chest pain even at rest.
Normal at rest.
Diagnosis : by history Diagnosis : You have to Diagnosis : No need to make
have both cardiac enzymes cardiac enzymes test if ECG
file & ECG shows these changes.
Risk Factors : HTN Diabtes
mellitus smoking
Fxh
Male
>40y
Can cause sudden cardiac Cause death d/t Ventricular
death fib.
get worried if the ECG came normal but the pt have Risk Factors & present with angina =
unstable angina & can change to massive MI
Risk Factors :
Smoking
HTN
Spectrum of acute ischemia related syndromes.
Stenosis in the coronary artery or a thrombus maybe present causing partial occlusion of the
artery. Leading to MI (STEMI or NSTEMI)
Stable angina → Unstable angina → STEMI → NSTEMI & all share the same pathophysiology.
Pt at risk of MI
Prinzmetal’s angina → in Female d/t vasospasm of the coronary artery.
Signs & Symptoms :-
Chest pain =angina on exertion (main main symptom)
→ radiates to the left arm commonly but can also go to the right arm.
→crushing or pressure feeling pain
Started as chest pain while exertion then rest the pain resolve
But now it is chest pain even at rest
The dr will start to think 1. He is having coronary stenosis. 2. The stenosis is getting worse.
& the pt may develop from stenosis to complete occlusion.
Diaphoresis → increase sweating
S3 → d/t acute heart failure
SBP <80 mmHg
Pulmonary crackles
Causes :
Stenosis
Plaque rupture
Thrombus
Vasospasm → prinzmetal’s angina
Surgery → during CABG
In stent thrombosis
Investigations :
History
ECG changes
, Cardiac markers
Then after investigations, classify the pt for Diagnosis :
Unstable angina NSTEMI STEMI
Stenosis of the artery Thrombosis is there & a part Complete artery occlusion by
(No thrombus) of the fibrous cap rutured the thrombosis & platelet
causing the platelet to adhere aggregation.
& aggregate. This partially
occlude the artery. So no
changes in heart tissue.
No ECG changes On ECG : On ECG:
ST- depression ST elevation
T-wave inversion LBBB
Normal cardiac enzymes High cardiac enzyme All cardiac enzymes are high.
(troponin levels are high)
CK-MB high
Chest pain while walking. Chest pain even at rest. Chest pain even at rest.
Normal at rest.
Diagnosis : by history Diagnosis : You have to Diagnosis : No need to make
have both cardiac enzymes cardiac enzymes test if ECG
file & ECG shows these changes.
Risk Factors : HTN Diabtes
mellitus smoking
Fxh
Male
>40y
Can cause sudden cardiac Cause death d/t Ventricular
death fib.
get worried if the ECG came normal but the pt have Risk Factors & present with angina =
unstable angina & can change to massive MI
Risk Factors :
Smoking
HTN
