This document discusses acute coronary syndrome (ACS), which is classified into STEMI and NSTE-ACS (which includes NSTEMI and unstable angina). NSTE-ACS is caused by an imbalance between myocardial oxygen supply and demand, due to issues like plaque rupture or coronary artery spasm. It presents with chest discomfort at rest or with minimal exertion. ECG may show new ST depression while cardiac biomarkers like troponin are elevated. Treatment involves medical management with anti-ischemic drugs, anti-thrombotics, and sometimes revascularization. STEMI is caused by an abrupt decrease in coronary blood flow and presents with more severe chest pain. Initial management focuses on reperfusion therapy like PCI or fibrinolysis to limit

1. ACUTE CORONARY
SYNDROME
BY
SUJA S KUMAR

2. ACUTE CORONARY SYNDROME
• Classified into 2 groups
• STEMI
• NSTE-ACS
– NSTEMI
– Unstable angina

5. NSTE-ACS

6. PATHOPHYSIOLOGY
• NSTE-ACS
• Imbalance between myocardial O2 supply and
demand due to 1 or more of the following:
– 1.disruption of an unstable coronary plaque due to
plaque rupture,erosion,/calcified protruding nodule-
intracoronary that lead to intracoronary thrombus
formation and inflamatory process
– 2.coronary arterial vasoconstriction
– 3.gradual intraluminal narrowing
– 4.fever,tachycardia, thyrotoxicosis in presence of fixed
epicardial coronary obstruction

9. CLINICAL PRESENTATION
• Chest discomfort
– Occurrence at rest/with minimal exertion lasting
>10 min
– Relatively recent onset
– Cresendo pattern
– ie; distinctly more severe , prolonged ,frequent
than previous episode

11. ECG
• New ST segment depression
• May be transient
• But last for several days follwing NSTEMI
• T wave changes :common , but less specific
• Unless new and deep T wave
inversion(>/=0.3mV)

12. CARDIAC BIOMARKERS
• ELEVATED BIOMARKERS OF NECROSIS:
– CARDIAC TROPONIN(cTn) I or T
– CK -MB

14. DIAGNOSTIC EVALUATION
• ECG
• Cardiac biomarkers
• Stress testing
• CCTA
• Goals:
– Recognise & exclude MI- cardiac biomarkers,cTn
– Detect rest ischemia-ECG
– CCTA to detect coronary obstruction at rest

15. TREATMENT
• Medical treatment
• Anti Ischemic treatment
• Anti thrombotic therapy
• Anti platelet
• Anticoagulant

20. PRINZMETAL’S ANGINA
• Syndrome of severe ischemic pain
• Usually occur at rest
• Associated with transient ST segment
elevation
• Caused by focal spasm of an epicardial
coronary artery and transmural ischemia and
abnormalities in left ventricular function
• Leading to acute MI, VT/VF ,sudden cardiac
death

21. TREATMENT
• Nitrates
• Calicium channel blockers
• Statin therapy reduces the risk of major
adverse events
• Coronary revasularization

22. ST SEGMENT ELEVATION MI-
STEMI
• Coronary blood flow decreases abruptly

23. CLINICAL FEATURES
• Precipitating factors
– Vigorous physical exercise
– Emotional stress/medical/surgical illness
• Pain:
 deep and visceral
 Heavy,squeezing,& crushing/stabbing/burning
 Occurs at rest
 More severe & last longer
 Central portion of chest &/epigastrium
 Radiates
 weakness
• Sweating,nausea,vomiting,anxiety,sense of impending doom

24. PHYSICAL FINDINGS
• Anxious and restless
• Substernal chest pain > 30 min,
• Diaphoresis
• Anterior infarction: sympethetic N.S.
hyperactivity
• Precordium : quiet, apical impulse difficult to
palpate
• Anterior wall infarction :abnormal systolic pulse

25. LAB PARAMETERS
• ECG
• Serum cardiac biomarkers
• Cardiac imaging

27. INITIAL MANAGEMENT
• Prognosis depends on occurrence of
complications:
– Electrical complications(Arrythmias) and
mechanical complications (pump failure
• Prehospital care:
– Recognition
– Medical team and resuscittion
– Expeditous transportation of patient
– Expeditious implementation of reperfusion therapy

28. MANAGEMENT IN EMERGENCY
DEPARTMENT
• Cardiac discomfort
– Sublingual nitroglycerin 0.4 mg
– Morphine
– IV beta blockers
• Identify candidates for urgent reperfusion therapy
• Limitation of infarct size
– Primary Percutaneous Coronary intervention
– Fibrinolysis
– Integrated reperfusion strategy

30. HOSPITAL PHASE MANAGEMENT
• Coronary care units
• Activity
• Diets
• Bowel management
• Sedation

31. PHARMACOTHERAPY
• Antithrombotic agents
• Beta adrenoceptor blockers
• Inhibition of RAAS

32. COMPLICATIONS AND ITS
MANAGEMENT
• Ventricular dysfunction
• Hemodynamic assesment
• Hypovolemia

33. THANK YOU