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32505912 chest-pain-final

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This document discusses the evaluation and management of patients presenting with chest pain. It covers risk factors for cardiac causes, the role of enzymes and ECG in diagnosis, differential diagnoses, strategies for high-risk vs. low-risk patients, and treatments including medications, observation, cardiac catheterization, and percutaneous coronary intervention.

Health & Medicine
1 of 143
Chest Pain Evaluation
Content. ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
What time of day is it?
 
How do you keep up with the stats/subset argument? ,[object Object],[object Object],[object Object],[object Object]
Common Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ATTACK the Clot or the Lesion?
A paradigm issue ,[object Object],[object Object],[object Object]
Acute chest pain ::::inputs
Acute chest pain ::::outcomes ,[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
ENZYMES. Most labs now only doing Troponin 1 (huge topic, Quality Control Issue). BUT not good early: - Rise at 3-6 - Peak at 14-18 - Stays for days. CAN WE USE IN ED TO SEND HOME? NO
Cases .
45yr male patient with Chest pain ,[object Object],[object Object]
At triage. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
65 yr male with chest pain. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Is this ACS? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Consider ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If no ECG changes or N ECG what then? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Re-evaluate pts for High risk Status According to the following criteria: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If all of the above are Negative ,[object Object],[object Object],[object Object],[object Object]
If Positive for high risk ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why Use Low Molecular Wt Heparin (LMWH)?.
Superior outcomes with Enoxaparin ,[object Object]
LMWHs obtain antithrombotic levels within ? Time. ,[object Object],[object Object],[object Object]
What is the bioavailability of the LMWH vr UFH ,[object Object],[object Object]
 
 
65 yr female. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG shows. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If Catherization is Normal ,[object Object],[object Object],[object Object],[object Object],[object Object]
Glycoprotein GP IIb/IIIa inhibitors ,[object Object],[object Object]
phase III-(GUSTO)-V trial ,[object Object],[object Object],[object Object]
PCI ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is the optimal approach for establishing coronary reperfusion after myocardial infarction? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alternative Strategy (NQWMI) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
34 yr male ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG shows. ,[object Object],[object Object],[object Object]
Treat with ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
If institutions not able to perform PCI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical evidence of reperfusion? ,[object Object],[object Object],[object Object],[object Object]
Fibrinolytic Therapy: The Current Landscape ,[object Object],[object Object],[object Object],[object Object],[object Object]
Compared to standard therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
From an outcome-effectiveness perspective ,[object Object],[object Object],[object Object]
 
Ideal fibrinolytic agent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Candidacy for Fibrinolysis—patient Screening, Identification, and Stratification ,[object Object],[object Object]
[object Object],[object Object],[object Object]
TIMI Risk Factor Analysis ,[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
Patient Age ,[object Object],[object Object],[object Object]
Time from Chest Pain Onset, Therapeutic Window. ,[object Object],[object Object],[object Object],[object Object]
Stroke. ,[object Object],[object Object],[object Object]
Recent Surgery and Trauma. ,[object Object],[object Object],[object Object],[object Object]
Elevated Blood Pressure. ,[object Object],[object Object]
Hypertension. ,[object Object]
[object Object],[object Object]
Cardiogenic Shock ,[object Object],[object Object]
Menstrual Bleeding ,[object Object],[object Object],[object Object]
[object Object]
The Electrocardiogram. ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
ST elevation “ on arrival” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Recent Cardiopulmonary Resuscitation (CPR). ,[object Object],[object Object]
Role Models.
Low Molecular Weight Heparin (Enoxaparin)— A Central Role in Fibrinolytic Regimens ,[object Object],[object Object]
[object Object],[object Object]
[object Object]
Coronary Stenting. ,[object Object],[object Object]
GP IIb/IIa Inhibitors. ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral Platelet Antagonists— The Role of Clopidogrel Pretreatment ,[object Object]
[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Some more antiplatelet agent apart from aspirin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How do Glycoprotein IIB/IIIA work? ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ST elevation “ on arrival”::PTCA ,[object Object],[object Object],[object Object],[object Object]
ST elevation “ on arrival”::PTCA ,[object Object],[object Object]
ST elevation “ on arrival”::PTCA ,[object Object],[object Object],[object Object]
NEW concept Facilitated PCI PACT trial. ,[object Object],[object Object],[object Object],[object Object]
ST elevation “ on arrival”:::: CABG ,[object Object]
ST elevation “ on arrival ,[object Object],[object Object],[object Object],[object Object]
Current practice. ,[object Object],[object Object]
 
 
 

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32505912 chest-pain-final

  • 1. Chest Pain Evaluation
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  • 51. ENZYMES. Most labs now only doing Troponin 1 (huge topic, Quality Control Issue). BUT not good early: - Rise at 3-6 - Peak at 14-18 - Stays for days. CAN WE USE IN ED TO SEND HOME? NO
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