BO- Card Cath Lab: ACS

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BO- Card Cath Lab: ACS

  1. 1. ACS and PCI Lecture for 3 rd Year Medical Students Cardiology Division University of Virginia
  2. 2. HPI <ul><li>53 y/o WM with HTN, HL, and 30 pyh of tobacco abuse who presents with 20 minutes of substernal chest pain </li></ul><ul><li>On EMS arrival, he gets an ECG and during transport has transient complete heart block </li></ul>
  3. 3. Risk Factors for CAD <ul><li>Age </li></ul><ul><li>Race </li></ul><ul><li>Gender </li></ul><ul><li>Hypertension </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Diabetes Mellitus </li></ul><ul><li>Smoking </li></ul><ul><li>Family History </li></ul><ul><li>Obesity </li></ul><ul><li>Others </li></ul>
  4. 4. Physical Exam <ul><li>T=36.7 HR=77 BP=130/90 bilaterally </li></ul><ul><li>HEENT: 10cm JVD </li></ul><ul><li>CV: s4,s1,s2 no murmur/ rub/ heave </li></ul><ul><li>Lungs: bilateral rales at bases </li></ul><ul><li>Pulses: 2+ throughout; no bruits </li></ul>
  5. 5. EKG
  6. 6. Differential Diagnosis <ul><li>Acute Myocardial Infarction </li></ul><ul><li>Aortic Dissection </li></ul><ul><li>Prinzmetal’s Angina </li></ul><ul><li>Acute Pericarditis </li></ul><ul><li>Early Repolarization </li></ul><ul><li>Acute Takosubo’s Cardiomyopathy </li></ul><ul><li>Etc… </li></ul>
  7. 7. Coronary Anatomy RCA dominant in 85% of patients
  8. 8. Treatment of STEMI <ul><li>Aspirin </li></ul><ul><li>Heparin </li></ul><ul><li>Beta Blocker </li></ul><ul><li>Thienopyridine </li></ul><ul><li>Fibrinolytics vs Primary Percutaneous Coronary Intervention (pPCI) </li></ul><ul><ul><li>IIb/IIIa Inhibitor </li></ul></ul>
  9. 9. Vascular Access
  10. 10. Wire Balloon Balloon Inflated P ercutaneous T ransluminal C oronary A ngioplasty P lain O ld B alloon A ngioplasty
  11. 11. Stent Deployment
  12. 12. Stent Deployment
  13. 13. RCA – LAO View
  14. 14. RCA – Balloon Angioplasty
  15. 15. Post Stent
  16. 16. Before and After
  17. 17. Questions/Comments

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