Acute Coronary Syndrome. Quick guide 2013
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Acute Coronary Syndrome. Quick guide 2013

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Acute Coronary Syndrome. Quick guide 2013

Acute Coronary Syndrome. Quick guide 2013
Myocardial Infarction.

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    Acute Coronary Syndrome. Quick guide 2013 Acute Coronary Syndrome. Quick guide 2013 Presentation Transcript

    • Francisco J. Chacón-Lozsán MD student UCLA-Venezuela European Society of Cardiology: Acute Cardiovascular Care Association LinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco 2013
    • 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.
    • 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)
    • Ischemia Q wave Ischemia Q wave must have: More of 0,04sec of duration. More of 25% or R wave of amplitude.
    • 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
    • subendocardyum subepicardyum
    • Hours Days
    • 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.
    • 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
    • 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.