CHest pain relieve management and reperfusion strategy in ACS patient - 2022

1. Chest Pain Relieve Management and
Reperfusion Strategy in ACS Patient
Bahrudin
Dept. of Cardiology and Vascular Medicine, Faculty of Medicine UNDIP - RSND

2. Acute Coronary Syndrome

3. Chest pain = angina pectoris
• Angina pectoris is a chest
discomfort due to ischemia of
heart muscles

4. • Heart rate
• Contractility
• Preload
• Afterload
• Coronary flow
• Regional myocardial
blood flow

O2
D
e
m
a
n
d

O2
S
u
p
p
l
y
HEART
Pathophysiology of angina pectoris

5. • Heart rate
• Contractility
• Preload
• Afterload
• Coronary flow
• Regional
myocardial blood
flow

O2
D
e
m
a
n
d

O2
S
u
p
p
l
y
-Blockers/Ca2+ channel blockers
Nitrates/ACE-I/ARB
Nitrates/Ca2+ channel blockers/
antithrombotics/ statins
HEART
Anti-angina based on the Pathophysiology
Revascularization

6. Dealing with factors associated with typical angina
1. Physical exertion (increase myocardial O2 demand)
2. Exposure to cold (cause elevation of BP increase oxygen demand)
3. Eating heavy meals
4. Stress or any emotion-provoking situation

7. Treatment of ACS
• Anti-ischemic therapies
• General measures:
• Antithrombotic therapies
Antiplatelet agents:
Anticoagulants (use one):
• Adjunctive therapies:
• Β-blocker
• Nitrates
• Pain control (morphine)
• Supplemental O2 if needed
• Aspirin
• Clopidogrel or ticagrelor
• GP IIb/IIIa inhibitor (for selected high
risk patients; may be deferred until PCI)
• LMWH (enoxaparin)
• Unfractionated intravenous heparin
• Fondaparinux
• Statin
• ACE-I or ARB

13. Treatment of Acute Coronary Syndromes
ST-Elevation
(STEMI)
Emergent PCI available
within 90 min
Fibrinolytic
Therapy
Non-ST-Elevation
(UA and NSTEMI)
Risk Assessment
(e.g., GRACE Score)
Primary PCI Conservative
Strategy
(Proceed to cardiac cath
only if recurrent angina
or predischarge
stress test is markedly
positive)
Invasive
Strategy
(Cardiac cath
leading to
PCI or CABG)
No Yes Low High

30. Thank you