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 :-
1. 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.
2. Diaphoresis → increase sweating
3. S3 → d/t acute heart failure
4. SBP <80 mmHg
5. Pulmonary crackles
Causes :
1. Stenosis
It has svereti:- · Mild or sever = unstable angina or NSTEMI
2. Plaque rupture
3. Thrombus
4. Vasospasm → prinzmetal’s angina
Female · Have atherosclerosis
5. Surgery → during CABG
6. In stent thrombosis
Investigations :
1. History
, 2. ECG changes
ST segment elevation > 1mm consecutively · Q-waves · Conduction defect → LBBB ·
3. Cardiac markers
The higher the enzyme level the worse the ischemia of the myocardium or cardiac da
Then after investigations, classify the pt for Diagnosis :
Unstable angina NSTEMI STEMI
Stenosis of the artery Thrombosis is there & a Complete artery occlusion
(No thrombus) part of the fibrous cap by the thrombosis & platelet
rutured causing the platelet aggregation.
to adhere & 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
(troponin levels are high) 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
have both cardiac enzymes make cardiac enzymes test
file & ECG if 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
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 :-
1. 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.
2. Diaphoresis → increase sweating
3. S3 → d/t acute heart failure
4. SBP <80 mmHg
5. Pulmonary crackles
Causes :
1. Stenosis
It has svereti:- · Mild or sever = unstable angina or NSTEMI
2. Plaque rupture
3. Thrombus
4. Vasospasm → prinzmetal’s angina
Female · Have atherosclerosis
5. Surgery → during CABG
6. In stent thrombosis
Investigations :
1. History
, 2. ECG changes
ST segment elevation > 1mm consecutively · Q-waves · Conduction defect → LBBB ·
3. Cardiac markers
The higher the enzyme level the worse the ischemia of the myocardium or cardiac da
Then after investigations, classify the pt for Diagnosis :
Unstable angina NSTEMI STEMI
Stenosis of the artery Thrombosis is there & a Complete artery occlusion
(No thrombus) part of the fibrous cap by the thrombosis & platelet
rutured causing the platelet aggregation.
to adhere & 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
(troponin levels are high) 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
have both cardiac enzymes make cardiac enzymes test
file & ECG if 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
