Acute coronary syndrome

1. ACUTE CORONARY
SYNDROME

2. • CORONARY ARTERY DISEASE
Chronic stable Acute coronary syndrome
Angina
Unstable angina STEMI
NSTEMI

4. Normal coronary artery

6. ANGINA PECTORIS
• Angina pectoris is a clinical syndrome
usually characterized by episodes or
paroxysms of pain or pressure in the
anterior chest

7. PRECIPITATING FACTORS OF
ANGINA
• Physical exertion
• Exposure to cold
• Eating a heavy meal
• Stress or any emotion-provoking situation
• Sexual activity

9. Chronic stable angina
• It refers to chest pain that occurs
intermittently over a long period with same
pattern of onset, duration and intensity of
symptoms
• Characteristics of pain become different

10. Unstable angina
• also called preinfarction angina or
crescendo angina
• symptoms occur more frequently and last
longer than stable angina. The threshold
for pain is lower, and pain may
occur at rest.

11. Silent ischemia
• It refers to ischemia that occurs in the
absence of any subjective symptoms
• Patients with diabetes have increase
prevalence of silent ischemia

12. Variant angina/Prinzmetal
angina
• It is a varient often occurs at rest, usually
in response to spasm of a major coronary
artery

13. Assessment and Diagnostic
Findings
• Exercise stress testing
ST segment and T wave changes are
indirect assessment of corornary perfusion
• Cardiac catheterisation
• ECG
• C-reactive protein (CRP)
• Homocysteine

14. Medical Management
• objectives of the medical management of
angina are to decrease the oxygen
demand of the myocardium and to
increase the oxygen supply.
• Thereby preventing MI and death

15. Nitrates
• Short acting
• Long acting
• MOA- dilating peripheral blood vessels
dilating coronary artey and
collaterals

16. • Short acting- nitroglycerin- 5mg
sublingually- 1 tab sublingually,
• Long acting- Isosorbide dinitrate,
Isosorbide mononitrate

17. Beta adrenergic blockers
• It reduce myocardial oxygen consumption
by blocking the beta-adrenergic
sympathetic stimulation to the heart.
• The result is a reduction in heart rate,
slowed conduction of an impulse through
the heart, decreased blood pressure, and
reduced myocardial contractility (force of
contraction)

18. • Propranolol
• Metoprolol
• Atenolol

19. Calcium Channel Blocking
Agents
• MOA- decreases the movement of calcium
into membranes cardiac and arterial
muscle cells
• Eg- Nifidipine, verapamil and diltiazem

20. Antiplatelet and
Anticoagulant Medications
• Aspirin -Aspirin prevents platelet
activation and reduces the incidence of MI
and death in patients with CAD