Acute Coronary Syndrome. Quick guide 2013

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Acute Coronary Syndrome. Quick guide 2013
Myocardial Infarction.

Acute Coronary Syndrome. Quick guide 2013

  1. 1. Francisco J. Chacón-Lozsán MD student UCLA-Venezuela European Society of Cardiology: Acute Cardiovascular Care Association LinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco 2013
  2. 2. Normal Ischemia—Tall T Wave or inverted (infarction), ST segment depressed (angina) Damage— elevated ST segment, T wave inverted. Infraction (Acute)—Pathologic Q wave, elevated ST segment and T wave inverted. Infarction (previous)—Pathologic Q wave, ST-T can be normal.
  3. 3. J Point In 2 contiguous leads must have: ≥ 0,25 mV in males <40 years old. ≥ 0,2 mV in males >40 years old. ≥ 0,15 mV females in leads V2-V3 ≥ 0,1 mV other leads (in absence of left ventricular hypertrophy or LBBB)
  4. 4. Ischemia Q wave Ischemia Q wave must have: More of 0,04sec of duration. More of 25% or R wave of amplitude.
  5. 5. Derivation Affected Region Coronary Lesion V1, V2, V3 Antero-Septal Anterior Descendent V3, V4 Anterior Anterior Descendent V5, V6 Lower Lateral Circumflex, Right Coronary DI, aVL Upper Lateral Diagonal, Circumflex DII, DIII, aVF Inferior Right Coronary, Circumflex I lateral II Inferior III inferior aVR aVL lateral aVF inferior V1 septal V2 septal V3 anterior V4 anterior V5 lateral V6 lateral
  6. 6. subendocardyum subepicardyum
  7. 7. Hours Days
  8. 8. UNSTEMI’s Management Relieve angina using Nitrates. Patients using BB must continues using it if not Killip class >III Use BB in pateints with EF preserved. Calcium channel blockers are indicated in patients with nitrates and BB to relief symptoms. Use double antiplatelet theraphy: • If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned Heparin 70U/Kg EV + Atorvastatin 80mg. • To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned Heparin 60U/kg EV + Atorvastatin 80mg. Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV. If not: streptokinase: 1500.000U EV in 1hr.
  9. 9. A, indicates appropriate; CTO, chronic total occlusion; I, inappropriate; Int., intervention; Med., medical; Prox. LAD, proximal left anterior descending artery; Rx, treatment; U, uncertain; and vz., vessel
  10. 10. STEMI’s Management Star the chronometer. Calm pain: consider Opioids. Reduce anxiety: consider Tranquilizer in very anxious patients. Use oxygen in patients with SaO2<95%, breathlessness or with acute heart failure. Use double antiplatelet theraphy: • If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned Heparin 70U/Kg EV + Atorvastatin 80mg. • To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned Heparin 60U/kg EV + Atorvastatin 80mg. Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV. If not: streptokinase: 1500.000U EV in 1hr.

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