![بسم اللله الرحمن الرحيم ACUTE CORONARY SYNDROME SIMPLE NOTES Draz MY , Egypt 2008 Mb. Bch (Tanta), D. Sc (Al azhar) .,M. Sc (Cairo) ,M. Sc (Ain shams). Surgeon ,Internist, Emergency Registrar. [email_address]](https://image.slidesharecdn.com/cusersmohameddesktopacutecoronarysyndromedrazmyegypt2009-090929190518-phpapp02/85/ACUTE-MYOCARDIA-INFARCTION-ISCHEMIA-MI-Draz-MY-1-320.jpg)
![Atherosclerosis ,[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
More Related Content
What's hot
What's hot (20)
Similar to ACUTE MYOCARDIA INFARCTION ISCHEMIA MI Draz MY
Similar to ACUTE MYOCARDIA INFARCTION ISCHEMIA MI Draz MY (20)
Recently uploaded
Recently uploaded (20)
ACUTE MYOCARDIA INFARCTION ISCHEMIA MI Draz MY
- 1. بسم اللله الرحمن الرحيم ACUTE CORONARY SYNDROME SIMPLE NOTES Draz MY , Egypt 2008 Mb. Bch (Tanta), D. Sc (Al azhar) .,M. Sc (Cairo) ,M. Sc (Ain shams). Surgeon ,Internist, Emergency Registrar. [email_address]
- 3. RISK FACTORS AND PATHOGENESIS OF ATHEROMATOUS LESIONS OF ARTERIES.
- 10. V.TACH.,ASYSTOLE,MASSIVE MI SUDDEN DEATH ALTERED CONDUCTION DUE TO ISCH.OR INFARCTION ARRYTHMIA MYOCARDIAL DYSFUNCTIONDUE TO INFARCTION OR ISCH. HEART FAILURE MYONECROSIS DUE TO ACUTE ISCH. MI DYNAMIC CORONARY OBSTRUCTION UNSTABLE ANGINA FIXED CORONARY ATHEROMATOUS LESION STABLE ANGINA CORONARY HEART DISEASE : CLINICAL MANIFESTATIONS AND PROBLEMS
- 23. UNSTABLE ANGINA
- 24. Acute Coronary Syndrome Ischemic Discomfort Unstable Symptoms No ST-segment elevation ST-segment elevation Unstable Non-Q Q-Wave angina AMI AMI ECG Acute Reperfusion History Physical Exam
- 26. THROMBOSIS IN MYOCARDIAL INFARCTION SCORE FOR UNSTABLE AND NSTSMI
- 41. NSTSMI
- 49. STSEMI
- 68. In-stent Restenosis in small vessels treated with rotational atherectomy
- 72. Definite ACS Possible ACS (–) ECG; Normal biomarkers Observe; repeat ECG, markers at 4-8 hrs No recurrent pain; (–) follow-up studies Recurrent pain; (+) follow-up studies Stress test; LV function if ischemia (–) test: outpt follow-up (+) test Admit, Use Acute Ischemia Pathway ST Use MI Guidelines No ST ST-T ’s, chest pain, markers Symptoms Suggestive of ACS
- 73. Emergency Room Triage of Patients with Acute Chest Pain by Means of Rapid Testing for Cardiac Troponin T or Troponin I Christian W. Hamm, M.D., Britta U. Goldmann, M.D., Christopher Heeschen, M.D., Georg Kreymann, M.D., Jürgen Berger, Ph.D., and Thomas Meinertz, M.D. NEJM,Volume 337:1648-1653, Number 23 December 4, 1997 773 consecutive patients who had had acute chest pain for less than 12 hours without ST-segment elevation on their electrocardiograms, troponin T and troponin I status (positive or negative) was determined at least twice by sensitive, qualitative bedside tests based on the use of specific monoclonal antibodies.
- 74. Conclusions Bedside tests for cardiac-specific troponins are highly sensitive for the early detection of myocardial-cell injury in acute coronary syndromes. Negative test results are associated with low risk and allow rapid and safe discharge of patients with an episode of acute chest pain from the emergency room. 70 =22 % 44 =94 % 123 =16 % Tn.T +VE 114 =36 % 47 =100% 171 =22% Tn.I +VE 315 47 773 NO. UNSTABLE ANGINA MI.PATIENTS TOTAL PATIENTS
- 75. Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. Pope ET AL. Volume 342:1163-1170, Number 16, NEJM April 20, 2000
- 76. Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. Pope ET AL. Volume 342:1163-1170, Number 16, NEJM April 20, 2000 55 NON CARDIAC 21 NON ISCH.CARDIAC 6 STABLE ANGINA 9 UNSTABLE ANGINA 8 MI 17 ACUTE CARDIAC ISCH. % FROM TOTAL TOTAL NO.=10,689
- 77. 2.3% 22 966 UNSTABLE ANGINA 2.1% 19 889 ACUTE MI % OF TOTAL DISCHARGE FROM ED NO.
- 78. It appears that the incidence of missed diagnoses of acute cardiac ischemia in the emergency department may be reduced by: 1- Interpreting the electrocardiogram more accurately. 2- Addressing clinical factors or preconceptions that obscure the recognition of acute myocardial infarction and unstable angina in women and nonwhite patients. 3- Considering the possibility that acute cardiac ischemia may be present in patients with chief symptoms other than chest pain. 4- Assessing recent changes in the clinical course of angina more carefully.
- 79. الحمد لله رب العالمين
Editor's Notes
- In-stent restenosis is a proliferative disease disorder that leads to the phenomenon of late loss. In stetnting, a late loss of between .00 and 1 mm usually occurs. This leads to a significant reduction of luminal area of a stent. Late loss can result in up to a 56% reduction in the cross-sectional area in the average 3 mm vessel. In smaller vessels, the area obstruction is more severe with late loss contributing up to a 75% reduction in cross sectional area.
- Algorithms can be used to detail the appropriate therapies in practice. The guidelines use the same basic algorithm. The process is very dynamic and all aspects need to be considered. Evaluate the patient Determine if the patient has ACS or possible ACS Interpret the ECG and bio-markers Observe the patient Repeat measurements Some patients may present as troponin negative but over time become troponin positive without any other symptoms.