This document discusses the management of coronary artery disease and acute coronary syndrome. It begins with the anatomy of the heart and coronary blood vessels. It then defines acute coronary syndrome as unstable angina or myocardial infarction caused by plaque rupture and thrombosis. Risk factors for coronary artery disease are outlined. The diagnostic approach involves assessing symptoms, signs, electrocardiogram changes and cardiac biomarker levels. Treatment focuses on reopening the blocked vessel with medications, fibrinolytics or percutaneous coronary intervention. Chronic stable angina from established coronary artery disease is also discussed.
A 75-year-old diabetic male presented with chest pain and other symptoms of acute coronary syndrome. The most probable diagnosis is myocardial infarction. Relevant investigations include ECG, biochemical markers like CK-MB and troponin, and echocardiogram. Management involves medical therapy in emergency, possible fibrinolysis or PCI, and long term preventative treatment. Complications can include heart failure, cardiogenic shock, arrhythmias if not properly managed.
This document discusses acute coronary syndrome and thrombolytic therapy for STEMI. It defines ACS as a spectrum ranging from unstable angina to STEMI depending on the degree of coronary occlusion. For STEMI, the goals of early management are pain relief, early reperfusion, and treating complications to minimize heart muscle loss. Thrombolytic therapy with drugs like streptokinase or tenecteplase is recommended if initiated within 12 hours of symptoms to restore blood flow. Factors that indicate successful reperfusion and guidelines for concomitant medications, complications, and contraindications to thrombolysis are also summarized.
1) Acute coronary syndrome includes unstable angina and myocardial infarction, characterized by chest pain and elevated cardiac biomarkers.
2) Clinical features include severe, prolonged chest pain that may radiate to other areas, as well as syncope, vomiting, and arrhythmias.
3) Complications include heart failure, arrhythmias like ventricular fibrillation, cardiac rupture, and remodelling. Diagnosis involves ECG, cardiac enzymes, and angiography. Management focuses on reperfusion therapy, anticoagulation, and risk factor reduction.
1. The document discusses acute coronary syndrome (ACS), defining it as a group of clinical signs and symptoms consistent with acute myocardial ischemia.
2. It outlines the pathophysiology of ACS as being the result of progressive atherosclerosis leading to plaque rupture and thrombosis, potentially causing myocardial infarction.
3. Treatment options for ACS cases are discussed, including fibrinolysis, percutaneous coronary intervention (PCI), and optimal antiplatelet medication based on risk stratification. Managing ACS requires prompt diagnosis and revascularization in high-risk patients.
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
ا.د/شريف مختار
Acute coronary syndrome management
المحاضرة التي قدمت يوم الاربعاء 9 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
A 75-year-old diabetic male presented with chest pain and other symptoms of acute coronary syndrome. The most probable diagnosis is myocardial infarction. Relevant investigations include ECG, biochemical markers like CK-MB and troponin, and echocardiogram. Management involves medical therapy in emergency, possible fibrinolysis or PCI, and long term preventative treatment. Complications can include heart failure, cardiogenic shock, arrhythmias if not properly managed.
This document discusses acute coronary syndrome and thrombolytic therapy for STEMI. It defines ACS as a spectrum ranging from unstable angina to STEMI depending on the degree of coronary occlusion. For STEMI, the goals of early management are pain relief, early reperfusion, and treating complications to minimize heart muscle loss. Thrombolytic therapy with drugs like streptokinase or tenecteplase is recommended if initiated within 12 hours of symptoms to restore blood flow. Factors that indicate successful reperfusion and guidelines for concomitant medications, complications, and contraindications to thrombolysis are also summarized.
1) Acute coronary syndrome includes unstable angina and myocardial infarction, characterized by chest pain and elevated cardiac biomarkers.
2) Clinical features include severe, prolonged chest pain that may radiate to other areas, as well as syncope, vomiting, and arrhythmias.
3) Complications include heart failure, arrhythmias like ventricular fibrillation, cardiac rupture, and remodelling. Diagnosis involves ECG, cardiac enzymes, and angiography. Management focuses on reperfusion therapy, anticoagulation, and risk factor reduction.
1. The document discusses acute coronary syndrome (ACS), defining it as a group of clinical signs and symptoms consistent with acute myocardial ischemia.
2. It outlines the pathophysiology of ACS as being the result of progressive atherosclerosis leading to plaque rupture and thrombosis, potentially causing myocardial infarction.
3. Treatment options for ACS cases are discussed, including fibrinolysis, percutaneous coronary intervention (PCI), and optimal antiplatelet medication based on risk stratification. Managing ACS requires prompt diagnosis and revascularization in high-risk patients.
Chest pain Case Presentation with managementMuqtasidkhan
CASE presentation of chest pain types, causes, investigations, management. cardiac vs non cardiac pain. life threatening chest pain. MI, ACS, PNEUMOTHORAX, PE, GERD, AORTIC DISSECTION.
ا.د/شريف مختار
Acute coronary syndrome management
المحاضرة التي قدمت يوم الاربعاء 9 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
Acute coronary syndrome (ACS) refers to conditions caused by reduced blood flow in the coronary arteries. This can be due to plaque buildup narrowing the arteries or plaque rupture leading to clot formation. ACS includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Patients present with chest pain and may have ECG changes or elevated cardiac biomarkers. Treatment involves oxygen, nitroglycerin, aspirin, and morphine (MONA) along with long-term therapies like antiplatelets, beta-blockers, statins, and ACE inhibitors to prevent future events.
This document discusses the early management of suspected myocardial infarction (MI). It outlines key risk factors for cardiac events and recommendations for stabilizing, diagnosing, and treating patients presenting with chest pain. Diagnostic steps include electrocardiograms (EKGs), cardiac enzyme levels, and potentially angiography. Treatment involves aspirin, nitrates, anticoagulants, and potentially thrombolytics or angioplasty depending on the situation. Goals are to promptly diagnose and treat to reduce mortality from MI.
This document summarizes a seminar on ST-elevation myocardial infarction (STEMI). The seminar objectives were to define STEMI, describe its pathophysiology and presentations, understand diagnostic tests and their interpretation, diagnose and manage complications, and ensure appropriate secondary prevention. The seminar covered the epidemiology, pathophysiology, clinical features, investigations including ECG and cardiac biomarkers, management including reperfusion therapies, complications and post-STEMI risk stratification.
An 81-year-old woman with a history of hypertension, diabetes, heart disease and abdominal pain was admitted to the hospital for worsening abdominal pain. Her ECG showed signs of a previous heart attack. Cardiac enzyme levels were elevated, leading to a diagnosis of a non-ST elevation myocardial infarction (NSTEMI). Angiography revealed blockages in her coronary arteries, which were treated with stent placement. NSTEMIs are less severe than ST elevation MIs and are usually caused by partial blockages that damage part of the heart muscle.
Stable angina is chest pain caused by plaque buildup in the coronary arteries that reduces blood flow during physical exertion. Unstable angina involves chest pain at rest that is a sign that plaques are rupturing. A STEMI occurs when a plaque rupture causes a complete blockage, lacking oxygen to heart muscle. Diagnosis involves EKG, cardiac enzymes, and angiography. Treatment focuses on lifestyle changes, medications, and procedures to restore blood flow and prevent future events. Stress testing helps evaluate risk and guide management.
Acute coronary syndromes (ACS) include unstable angina and myocardial infarction, which are forms of coronary heart disease caused by reduced blood flow due to plaque rupture and clot formation in the coronary arteries. The document discusses the epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, and treatment of ACS. It provides details on evaluating patients using biomarkers, ECG, risk scores, restoring blood flow through procedures like PCI or fibrinolysis, and employing antiplatelet and anticoagulant medications in the early treatment of ACS.
This document provides an overview of ischemic heart disease and the management of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). It discusses the risk factors, presentation, diagnosis, and treatment strategies for STEMI including reperfusion therapies like primary percutaneous coronary intervention (PCI) and thrombolysis. It also reviews the management of NSTEMI/unstable angina, complications of myocardial infarction, and secondary prevention strategies including medications and lifestyle changes.
The document discusses myocardial infarction and acute coronary syndrome, providing definitions, causes, risk factors, types, pathophysiology, clinical manifestations, diagnostic measures, management, and nursing management of MI. It covers topics such as the epidemiology of MI/ACS, diagnostic criteria and biomarkers for diagnosis, treatments including percutaneous coronary intervention and fibrinolytic therapy, and complications of MI.
This document provides an overview of coronary heart disease and acute myocardial infarction (AMI). It discusses the pathophysiology and types of chronic and acute coronary syndromes, including chronic stable angina, unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). For each condition, it outlines the typical clinical presentation, diagnostic testing, management principles, and treatment options.
1) Coronary artery disease and myocardial infarction are caused by atherosclerosis and plaque buildup in the arteries leading to ischemia. Unstable angina is a change in a previously stable pattern of chest pain and is part of the acute coronary syndrome continuum.
2) Myocardial infarction is caused by a blockage of blood flow to the heart muscle leading to cell death. It is diagnosed through electrocardiogram changes and cardiac biomarker levels. Complications include arrhythmias and heart failure.
3) Heart failure occurs when the heart can no longer pump sufficiently to meet the body's needs. It can be caused by conditions like coronary artery disease damaging the heart muscle. Types include left or right ventricular failure and
This document discusses coronary artery disease (CAD) and ischemic heart disease (IHD). It defines IHD as a disease of the heart muscle resulting from a lack of oxygen due to an imbalance between myocardial oxygen requirements and supply. CAD is most commonly caused by atherosclerosis. The spectrum of IHD ranges from silent ischemia to myocardial infarction and heart failure. Acute coronary syndrome (ACS) refers to the unstable spectrum of IHD and includes unstable angina and myocardial infarction. Biomarkers, imaging, and risk scores are used to stratify patients according to their risk. Medical management involves anti-ischemic therapies, antiplatelet agents, and risk factor modification.
Ischemic heart disease (IHD) is caused by an imbalance between myocardial oxygen supply and demand. The most common cause is atherosclerosis leading to decreased blood flow. IHD presents as stable angina, acute coronary syndrome (ACS), or sudden cardiac death. ACS includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). STEMI is diagnosed based on ECG changes and cardiac enzyme levels and requires emergency reperfusion therapy. Risk factors include age, family history, smoking, diabetes, hypertension, and dyslipidemia. Management involves antithrombotic therapy, anti-ischemic drugs, revascularization, and controlling cardiovascular risk factors
The document discusses the current management of acute coronary syndrome in a non-interventional center. It outlines the definitions, processes of care, guidelines, and goals in diagnosing and treating ACS in the emergency department and hospital phases, including use of ECG, cardiac markers, medications, risk stratification, and addressing complications.
This document discusses the approach to evaluating and managing chest pain. It notes that chest pain is a common reason for emergency department visits and hospitalizations. A thorough history and physical exam is important to determine the likely cause, such as cardiac, pulmonary, gastrointestinal, or musculoskeletal origins. Initial testing may include an ECG, cardiac enzymes, chest x-ray, and echocardiogram. Life-threatening causes like myocardial infarction, pulmonary embolism, and aortic dissection require rapid diagnosis and treatment. Management depends on the identified condition but may include medications, procedures, or surgery.
Myocardial infarction occurs when there is a lack of oxygen supply to the heart muscle. It causes chest pain and is diagnosed through electrocardiograms and blood tests showing elevated cardiac enzyme levels. Treatment involves oxygen, pain medications, aspirin, and reperfusion therapies like thrombolysis or angioplasty to restore blood flow. Ongoing management focuses on lifestyle changes, medications to prevent future heart attacks, and cardiac rehabilitation.
Coronary artery disease (CAD) refers to a group of diseases caused by narrowing of the coronary arteries due to atherosclerosis. It includes conditions like stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A survey found that residents of public housing in Charlotte had several risk factors for CAD such as high blood pressure, high cholesterol, diabetes, and smoking. Diagnosis involves tests like ECG, cardiac markers, stress echocardiography, and coronary angiography. Treatment includes lifestyle changes, medications, angioplasty, stents, and coronary artery bypass grafting. Nursing management focuses on pre-procedure teaching, post-procedure monitoring for bleeding or other complications, and managing post-surgical
ACUTE CORONARY SYNDROME FOR CRITICAL CAREAbhinovKandur
The document defines acute coronary syndrome (ACS) as a group of diseases including unstable angina, myocardial infarction, and sudden cardiac death. ACS is classified into STEMI, NSTEMI, or unstable angina based on ECG and cardiac biomarker findings. The diagnosis of ACS involves taking a medical history, performing an ECG, and measuring cardiac biomarkers like troponin and CK-MB. Treatment involves pain relief medications, antiplatelet drugs, anticoagulants, and sometimes revascularization through procedures like angioplasty.
Acute Coronary Syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This can range from Unstable Angina to Non-ST-elevation Myocardial Infarction (NSTEMI) and ST-elevation Myocardial Infarction (STEMI). ACS is diagnosed based on symptoms, electrocardiogram (ECG) changes, and elevated cardiac biomarkers. Prompt treatment is important and may include medications, angioplasty, or bypass surgery depending on the severity and location of the blockage. Secondary prevention focuses on lifestyle changes and medications to prevent future cardiac events.
This document provides information on the management of angina pectoris. It discusses the different types of angina including stable angina, unstable angina, and variant angina. For stable angina, management includes general measures, drug treatment, and coronary artery revascularization if needed. Common antianginal drugs discussed are organic nitrates, calcium channel blockers, and beta-blockers. Unstable angina is treated with nitrates, beta-blockers, aspirin, and sometimes thrombolytics. Variant angina is managed with nitrates and calcium channel blockers.
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
Visit : https://massagespaajman.com/
Call : 052 987 1315
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Acute coronary syndrome (ACS) refers to conditions caused by reduced blood flow in the coronary arteries. This can be due to plaque buildup narrowing the arteries or plaque rupture leading to clot formation. ACS includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). Patients present with chest pain and may have ECG changes or elevated cardiac biomarkers. Treatment involves oxygen, nitroglycerin, aspirin, and morphine (MONA) along with long-term therapies like antiplatelets, beta-blockers, statins, and ACE inhibitors to prevent future events.
This document discusses the early management of suspected myocardial infarction (MI). It outlines key risk factors for cardiac events and recommendations for stabilizing, diagnosing, and treating patients presenting with chest pain. Diagnostic steps include electrocardiograms (EKGs), cardiac enzyme levels, and potentially angiography. Treatment involves aspirin, nitrates, anticoagulants, and potentially thrombolytics or angioplasty depending on the situation. Goals are to promptly diagnose and treat to reduce mortality from MI.
This document summarizes a seminar on ST-elevation myocardial infarction (STEMI). The seminar objectives were to define STEMI, describe its pathophysiology and presentations, understand diagnostic tests and their interpretation, diagnose and manage complications, and ensure appropriate secondary prevention. The seminar covered the epidemiology, pathophysiology, clinical features, investigations including ECG and cardiac biomarkers, management including reperfusion therapies, complications and post-STEMI risk stratification.
An 81-year-old woman with a history of hypertension, diabetes, heart disease and abdominal pain was admitted to the hospital for worsening abdominal pain. Her ECG showed signs of a previous heart attack. Cardiac enzyme levels were elevated, leading to a diagnosis of a non-ST elevation myocardial infarction (NSTEMI). Angiography revealed blockages in her coronary arteries, which were treated with stent placement. NSTEMIs are less severe than ST elevation MIs and are usually caused by partial blockages that damage part of the heart muscle.
Stable angina is chest pain caused by plaque buildup in the coronary arteries that reduces blood flow during physical exertion. Unstable angina involves chest pain at rest that is a sign that plaques are rupturing. A STEMI occurs when a plaque rupture causes a complete blockage, lacking oxygen to heart muscle. Diagnosis involves EKG, cardiac enzymes, and angiography. Treatment focuses on lifestyle changes, medications, and procedures to restore blood flow and prevent future events. Stress testing helps evaluate risk and guide management.
Acute coronary syndromes (ACS) include unstable angina and myocardial infarction, which are forms of coronary heart disease caused by reduced blood flow due to plaque rupture and clot formation in the coronary arteries. The document discusses the epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis, and treatment of ACS. It provides details on evaluating patients using biomarkers, ECG, risk scores, restoring blood flow through procedures like PCI or fibrinolysis, and employing antiplatelet and anticoagulant medications in the early treatment of ACS.
This document provides an overview of ischemic heart disease and the management of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). It discusses the risk factors, presentation, diagnosis, and treatment strategies for STEMI including reperfusion therapies like primary percutaneous coronary intervention (PCI) and thrombolysis. It also reviews the management of NSTEMI/unstable angina, complications of myocardial infarction, and secondary prevention strategies including medications and lifestyle changes.
The document discusses myocardial infarction and acute coronary syndrome, providing definitions, causes, risk factors, types, pathophysiology, clinical manifestations, diagnostic measures, management, and nursing management of MI. It covers topics such as the epidemiology of MI/ACS, diagnostic criteria and biomarkers for diagnosis, treatments including percutaneous coronary intervention and fibrinolytic therapy, and complications of MI.
This document provides an overview of coronary heart disease and acute myocardial infarction (AMI). It discusses the pathophysiology and types of chronic and acute coronary syndromes, including chronic stable angina, unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). For each condition, it outlines the typical clinical presentation, diagnostic testing, management principles, and treatment options.
1) Coronary artery disease and myocardial infarction are caused by atherosclerosis and plaque buildup in the arteries leading to ischemia. Unstable angina is a change in a previously stable pattern of chest pain and is part of the acute coronary syndrome continuum.
2) Myocardial infarction is caused by a blockage of blood flow to the heart muscle leading to cell death. It is diagnosed through electrocardiogram changes and cardiac biomarker levels. Complications include arrhythmias and heart failure.
3) Heart failure occurs when the heart can no longer pump sufficiently to meet the body's needs. It can be caused by conditions like coronary artery disease damaging the heart muscle. Types include left or right ventricular failure and
This document discusses coronary artery disease (CAD) and ischemic heart disease (IHD). It defines IHD as a disease of the heart muscle resulting from a lack of oxygen due to an imbalance between myocardial oxygen requirements and supply. CAD is most commonly caused by atherosclerosis. The spectrum of IHD ranges from silent ischemia to myocardial infarction and heart failure. Acute coronary syndrome (ACS) refers to the unstable spectrum of IHD and includes unstable angina and myocardial infarction. Biomarkers, imaging, and risk scores are used to stratify patients according to their risk. Medical management involves anti-ischemic therapies, antiplatelet agents, and risk factor modification.
Ischemic heart disease (IHD) is caused by an imbalance between myocardial oxygen supply and demand. The most common cause is atherosclerosis leading to decreased blood flow. IHD presents as stable angina, acute coronary syndrome (ACS), or sudden cardiac death. ACS includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). STEMI is diagnosed based on ECG changes and cardiac enzyme levels and requires emergency reperfusion therapy. Risk factors include age, family history, smoking, diabetes, hypertension, and dyslipidemia. Management involves antithrombotic therapy, anti-ischemic drugs, revascularization, and controlling cardiovascular risk factors
The document discusses the current management of acute coronary syndrome in a non-interventional center. It outlines the definitions, processes of care, guidelines, and goals in diagnosing and treating ACS in the emergency department and hospital phases, including use of ECG, cardiac markers, medications, risk stratification, and addressing complications.
This document discusses the approach to evaluating and managing chest pain. It notes that chest pain is a common reason for emergency department visits and hospitalizations. A thorough history and physical exam is important to determine the likely cause, such as cardiac, pulmonary, gastrointestinal, or musculoskeletal origins. Initial testing may include an ECG, cardiac enzymes, chest x-ray, and echocardiogram. Life-threatening causes like myocardial infarction, pulmonary embolism, and aortic dissection require rapid diagnosis and treatment. Management depends on the identified condition but may include medications, procedures, or surgery.
Myocardial infarction occurs when there is a lack of oxygen supply to the heart muscle. It causes chest pain and is diagnosed through electrocardiograms and blood tests showing elevated cardiac enzyme levels. Treatment involves oxygen, pain medications, aspirin, and reperfusion therapies like thrombolysis or angioplasty to restore blood flow. Ongoing management focuses on lifestyle changes, medications to prevent future heart attacks, and cardiac rehabilitation.
Coronary artery disease (CAD) refers to a group of diseases caused by narrowing of the coronary arteries due to atherosclerosis. It includes conditions like stable angina, unstable angina, myocardial infarction, and sudden cardiac death. A survey found that residents of public housing in Charlotte had several risk factors for CAD such as high blood pressure, high cholesterol, diabetes, and smoking. Diagnosis involves tests like ECG, cardiac markers, stress echocardiography, and coronary angiography. Treatment includes lifestyle changes, medications, angioplasty, stents, and coronary artery bypass grafting. Nursing management focuses on pre-procedure teaching, post-procedure monitoring for bleeding or other complications, and managing post-surgical
ACUTE CORONARY SYNDROME FOR CRITICAL CAREAbhinovKandur
The document defines acute coronary syndrome (ACS) as a group of diseases including unstable angina, myocardial infarction, and sudden cardiac death. ACS is classified into STEMI, NSTEMI, or unstable angina based on ECG and cardiac biomarker findings. The diagnosis of ACS involves taking a medical history, performing an ECG, and measuring cardiac biomarkers like troponin and CK-MB. Treatment involves pain relief medications, antiplatelet drugs, anticoagulants, and sometimes revascularization through procedures like angioplasty.
Acute Coronary Syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This can range from Unstable Angina to Non-ST-elevation Myocardial Infarction (NSTEMI) and ST-elevation Myocardial Infarction (STEMI). ACS is diagnosed based on symptoms, electrocardiogram (ECG) changes, and elevated cardiac biomarkers. Prompt treatment is important and may include medications, angioplasty, or bypass surgery depending on the severity and location of the blockage. Secondary prevention focuses on lifestyle changes and medications to prevent future cardiac events.
This document provides information on the management of angina pectoris. It discusses the different types of angina including stable angina, unstable angina, and variant angina. For stable angina, management includes general measures, drug treatment, and coronary artery revascularization if needed. Common antianginal drugs discussed are organic nitrates, calcium channel blockers, and beta-blockers. Unstable angina is treated with nitrates, beta-blockers, aspirin, and sometimes thrombolytics. Variant angina is managed with nitrates and calcium channel blockers.
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
Visit : https://massagespaajman.com/
Call : 052 987 1315
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Let's Talk About It: Breast Cancer (What is Mindset and Does it Really Matter?)bkling
Your mindset is the way you make sense of the world around you. This lens influences the way you think, the way you feel, and how you might behave in certain situations. Let's talk about mindset myths that can get us into trouble and ways to cultivate a mindset to support your cancer survivorship in authentic ways. Let’s Talk About It!
Joker Wigs has been a one-stop-shop for hair products for over 26 years. We provide high-quality hair wigs, hair extensions, hair toppers, hair patch, and more for both men and women.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
14. ACUTE CORONARY SYNDROME
Acute coronary syndrome is a term that encompasses
both unstable angina and myocardial infarction (MI).
It is characterised by new-onset or rapidly worsening
angina (crescendo angina), angina on minimal exertion or
angina at rest in the absence of myocardial damage.
In contrast, MI occurs when symptoms occur at rest and
there is evidence of myocardial necrosis, as
demonstrated by an elevation in cardiac troponin or
15. Introduction
Two steps to develop ACS: 1) developing
atherosclerosis plaque —> 2) ruptured AT plaque.
Development of at plaque in the coronary artery cause
stable angina which called myocardial ischemia.
Ischemia is an inadequate blood supply to the organ
that results subsequently in infarction, which is
localized area of necrosis.
16. The common mechanism to all ACS is rupture or erosion of
the fibrous cap of a coronary artery plaque.
This leads to platelet aggregation and adhesion, localized
thrombosis, vasoconstriction and distal thrombus
embolization.
The presence of a rich lipid pool within the plaque and a
thin fibrous cap are associated with an increased risk of
rupture.
Thrombus formation and the vasoconstriction produced by
17. Most important risk factors
Modifiable
Serum lipid levels
Hypertension
Smoking/tobacco use
Sedentary lifestyle
Obesity
Diabetes mellitus
Diet
Non modifiable
Age
Gender
Ethnicity
Family history
Genetics
Menopause
22. HOW TO APPROACH TO CHEST
PAIN?
Clinical presentation
Patients with an ACS may complain of a new onset of
chest pain, chest pain at rest, or a deterioration of pre-
existing angina.
However, some patients present with atypical features
including indigestion, pleuritic chest pain or dyspnoea.
23. Physical examination can detect alternative diagnoses
such as aortic dissection, pulmonary embolism or
peptic ulceration.
In addition it can also detect adverse clinical signs such
as hypotension, basal crackles, fourth heart sounds
and cardiac murmurs.
24. Site & onset: substernal, severe & persistent pain.
Character: dull, heavy and pressure-like pain.
Radiation: shoulders, arms, and jaws.
Associated symptoms:
○ sympathetic effect: diaphoresis, cool and clammy skin,
palpitation and syncope.
○ Parasympathetic effect: nausea, vomiting & weakness
SIGNS & SYMPTOMS
25. ○ Inflammatory response: Mild fever
Cardiac findings:
○ S4 (and S3 if systolic dysfunction present) gallop.
○ Systolic murmur (if mitral regurgitation or VSD).
Other: ○ Pulmonary rale (id heart failure present)
○ Jugular venous distention (if heart failure
or right vent. MI)
26. What Are the Differential Diagnosis of Chest Pain?
Non-ischaemic causes of chest pain
27. ECG
Electrocardiogram is usually done to monitor the ST segment.
➢ ST segment elevation is seen with STEMI due to transmural
ischaemia.
New ST Elevation at the J point in V2-3 of at least two contiguous
leads; ≥2mm in men and ≥1.5mm in women
New ST Elevation in the J point of at least 1mm in two contiguous
leads (except for V2-3)
➢ A T-wave inversion and Q wave (not present normally) are highly
suggestive for ACS. They may not appear during the first day of
onset, so your diagnosis can’t be based upon them.
28. ➢ Note that normal ECG does not exclude the possibility of ACS.
50% of patients with NSTE-ACS have normal ECG
➢ ECG must be performed as soon as the patient presents to the
ER. In fact ECG must be performed upon anyone who presents with
chest pain of any cause.
29.
30.
31.
32.
33. CARDIAC BIOMARKERS
● Elevated ck-mb and troponin-i indicate STEMI or
NSTEMI. (Because there is necrosis) ● normal ck-mb and
troponin-i indicates unstable angina.
● Ck-mb is used to detect reinfarction (because it returns
to normal before troponins).
34. Troponin - Cardio-specific proteins. - Troponin I, and T are the most
sensitive & specific markers for myonecrosis. - Released with 4-6hrs, but
can last upto 2 week
Creatine Kinase (CK) - Creatine Kinase (CK) is released from multiple
organs such as the myocardium, skeletal muscles, and the brain. - The Iso-
form CK-MB, is cardio-specific. (Not that much specific) - Starts to rise 4-6
hrs after onset of ischemia, then falls within 48-72 hrs.
35.
36. TIMI Risk score (Predict 30d and 1yr mortality in UA/NSTEMI)
1. Age >= 65 yo
2. Markers (Elevated cardiac biomarkers)
3. ECG (ST segment deviation (>=0,5 mm)
4. Risk factors (3 or more CAD)
5. Ischemic chest pain (at least 2 or more anginal events in < 24 hours.
6. Coronary stenosis (prior stenosis of 50% or more)
7. Aspirin usage in past 7 days.
39. Nursing Management of ACS
The aim of the therapy is to:
1. Open Artery and Improve oxygen supply:
a. Supplemental O2 (ONLY if O2 Sat < 95%
b. Coronary vasodilators (Nitroglycerine) (increase supply and
dilates systemic veins (decrease preload and thus O2 demand)
c. Antiplatelet agents
d. Reperfusion therapy by 2 ways:
i. Fibrinolytic therapy
ii. Primary Percutaneous coronary intervention (PCI)
e. Antithrombotic agents.
40. 2. Reduce O2 demand:
a. Beta blockers (Block the stimulation of heart
contractility and therefore reduce o2 demand)
b. b. Analgesics (Morphine) (analgesic as well as
vasodilator)
3. Other medications:
a. ACE inhibitors. (acts as a vasodilator)
b. b. Statin therapy. (Pleiotropic effect) (reduction in
the plaque lipids which will make the plaque
more stable)
41.
42. Anti-ischemic Therapy
● BB - COMMIT-CCS trial Day 2-15
○ Reduced the endpoint of death/ MI/ cardiac arrest
○ 1 month up to 3 year for normal LVEF
● ACEI - ISIS-4 6 weeks, PEACE no benefit
● Statin - Superior stabilization of vulnerable plaque
● NTG
● PPI
● Regular activities - 1 week if revascularized/ 1 month for sports
43. Antiplatelets
1. Aspirin (ASA): Aspirin will inhibit cox-1 enzyme which lead to inhibition
of platelet aggregation . Chewable 160 to 325 mg at presentation, then
75 to 325 mg daily.
2. P2Y12 inhibitors (G-inhibitory-protein receptor in the platelet
membrane): (can be used for patients with aspirin allergy) More potent
than ASA and is combined with ASA and both agents are powerful
adjuncts to reperfusion therapy. Examples: Clopidogrel, Ticagrelor and
Prasugrel.
44. Reperfusion therapy:
1- Fibrinolytics (Thrombolytics): (door to needle time < 30 min)
● ONLY USED FOR STEMI (NOT NSTEMI).
● Reduces short and long term mortality following MI.
● Should be given during a 12hr window, and given As soon as possible.
There is no benefit if you give it after 12 hrs. Because after 12hrs the
damage that has been done to the heart is irreversible so reperfusion by
fibrinolytic won't be useful
● If Fibrinolytics fails after 30-60 minutes, refer to PCI.
45. There are 2 types of fibrinolytics:
1. Non Fibrin specific: Streptokinase.
2. Fibrin specific: Tenecteplase (TNK) - Alteplase (first
choice) - Reteplase.
46. Absolute Contraindications to thrombolytic therapy
➔ Any prior intracranial haemorrhage.
➔ Know cerebral vascular lesion.
➔ Known intracranial neoplasm.
➔ Ischaemic stroke within past 3 months.
➔ Recent major trauma/surgery/head injury (within 3 months)
➔ Active bleeding or Known bleeding disorder ( excluding
menstruation)
➔ Suspected Aortic dissection.
47. Relative Contraindications to thrombolytic therapy
➔ Oral anticoagulant therapy (example: Warfarin)
➔ Pregnancy or within 1 week postpartum.
➔ Noncompressible vascular punctures
➔ Traumatic resuscitation
➔ Poor controlled Refractory hypertension (systolic blood pressure
>180 mmHg)
➔ Internal bleeding, e.g. active peptic ulcer
➔ Dementia.
48. 2- Revascularization (surgical):
An angiography must be done first.
PCI (Percutaneous coronary intervention)
The procedure only aims to remove the clot, but a stent 3 could be placed in
the artery to improve the outcome. Preferred treatment for STEMI, as long
as it’s performed within 90 minutes from patient’s admission. (door to
balloon time < 90 mins)
CABG (Coronary Artery Bypass Graft)
49.
50. CHRONIC CORONARY SYNDROME
Chronic coronary syndromes, also called stable coronary artery
disease (CAD), stable ischemic heart disease (SIHD), chronic
stable angina or stable angina pectoris, is a clinical syndrome
characterized by squeezing, heaviness or pressure discomfort in the
chest, neck, jaw, shoulder, back, or arms which is usually precipitated
by exertion and/or emotional stress and relieved by rest and/or
Nitroglycerin.
51. It is caused by myocardial ischemia that is commonly associated
with narrowing of the coronary arteries.
•Obstructive CAD has ≥50% stenosis while nonobstructive CAD has
<50% stenosis
Angina is stable when it is not a new symptom and when there is no
deterioration in frequency, duration or severity of episodes
52. CAD indicates coronary artery disease; INOCA, ischemia and no obstructive coronary artery
disease; MINOCA, myocardial infarction and no obstructive coronary artery disease; NSTEMI,
non–ST-segment–elevation myocardial infarction; STEMI, ST-segment–elevation myocardial
infarction; and UA, unstable angina. (AHA)
53. Epidemiology
•Leading cause of death worldwide
•Global prevalence of ischemic heart disease in 2020 is 138/100,000 in
males and 90/100,000 in females
•Prevalence in 2020 ranges from 1556-<3345/100,000 in Southeast
Asia
Pathophysiology
•Due to inadequate blood supply to the myocardium as a result of
obstruction of the epicardial coronary arteries usually resulting from
atherosclerosis
54. Signs and Symptoms
•Quality of chest pain
• Described as squeezing, grip-like, suffocating and heavy pain but rarely
sharp or stabbing and typically does not vary with position or
respiration
• Occasionally, the patient may demonstrate a Levine’s sign in which a
clenched fist is placed over the precordium to describe the pain
• Many patients do not describe angina as frank pain but as tightness,
pressure or discomfort
55. •Other patients, particularly women and elderly, can manifest with atypical
symptoms such as nausea, vomiting, midepigastric discomfort or sharp
(atypical) chest pain
•Location of pain or discomfort
• Usually substernal and pain can radiate to the neck, jaw, epigastrium,
shoulders, back or arms
• Pain above the mandible, localized to a small area over the left lateral
chest wall or below the epigastrium is rarely anginal
•Duration of pain
• Lasts for minutes, usually not >20 minutes
59. Rule Out Unstable Angina
•Unstable angina is defined as angina of new onset, increases in
frequency, intensity or duration, or occurs at rest
•Presence of unstable angina predicts a higher short-term risk of acute
coronary event
•Moderate- to high-risk patients should be promptly evaluated and
treated in the emergency department because of higher risk of
coronary artery plaque rupture and death
•Low-risk patients are comparable to those patients with stable angina
and their evaluation can be performed safely and expeditiously in an
outpatient setting
60. Clinical Classification of Chest Pain
Typical angina (definite or stable) has (1) substernal chest discomfort
with a characteristic quality and duration provoked by exertion and/or
emotional stress and (2) relieved by rest and/or Nitroglycerin within
minutes
Atypical angina (probable) has two of the characteristics of typical angina
Noncardiac/anginal chest pain only has one or none of the characteristics
of typical angina
61. Physical Examination
•It is usually normal or nonspecific in stable angina patients
•Exam during or immediately after an episode of pain may be beneficial
since S4 or S3 heart sound or gallop, mitral regurgitation murmur,
paradoxically split S2, basilar rales or chest wall heave that dissipates when
pain decreases are all predictive of IHD
•Careful CV exam may reveal other related conditions such as heart failure,
valvular heart disease or hypertrophic cardiomyopathy
•Audible rub suggests pericardial or pleural disease
62. •Presence of carotid bruit, renal artery bruit, diminished pedal pulse or
palpable abdominal aneurysm are evidences of vascular disease
•Elevated blood pressure (BP), xanthomas and retinal exudates are signs
which suggest the presence of IHD risk factors
•Chest pain elicited by pressure on the chest wall can be caused by
musculoskeletal syndromes but does not eliminate the possibility of angina
due to IHD
•Body mass index (BMI), waist circumference and waist-to-hip ratio should
also be taken to determine possible metabolic syndrome, non-coronary
vascular disease and other signs of comorbid conditions
63. Laboratory Tests
•Fasting lipid profile
•Fasting blood glucose and glycated hemoglobin (HbA1c)
• Complete blood count (CBC)
• Serum creatinine
• Cardiac enzymes (troponins, creatine kinase)
• Liver function tests
• Thyroid function test
Imaging
• Chest X-ray
64. Non-invasive Cardiac Investigations
Resting Electrocardiogram (ECG)
Resting Echocardiography
Exercise ECG or ECG Stress Test
Stress Testing in Combination with Imaging
Computed Tomography (CT)
Cardiac Magnetic Resonance Imaging (CMR)
Ambulatory Electrocardiogram (Holter) Monitoring
Coronary Computed Tomography Angiography (CCTA)
Invasive Cardiac Investigation
Invasive Coronary Angiography (ICA)
67. Prevention
Influenza Vaccination especially for the elderly
Coronavirus Disease 2019 (COVID-19) Vaccine
Pneumococcal Vaccine
Follow-up and Monitoring
Patient Education
Lifestyle Modification
68. Nursing Care Plan for Acute Coronary Syndrome
Immediately assess the patient to identify whether the symptoms are chest
pain (angina) or myocardial infarction (MI).
Obtain ECG during chest pain symptoms
MI is require immediate intervention to save cardiac tissue.
As soon as an acute mi patient is brought to the emergency room, steps are
taken to reduce ischemia, relieve pain, and stop progressive circulatory
collapse and shock.
The MONA regimen is started (morphine, oxygen, nitrates, and aspirin).
69. The patient is placed on a cardiac monitor.
Iv access is established for the administration of fluids and emergency
medications.
Additional tests and procedures, such as cardiac catheterization or
CABG, may be required.
The nurse encourages and educates the patient on medication
adherence, diet and weight management, and risk factor modification
after mi.
Cardiac rehabilitation programs may be advised after discharge for
ongoing recovery.
70. Administer thrombolytic therapy as ordered.
Administer beta blockers as ordered.
Establish IV access for the immediate administration of medication, IV
fluids, and blood products.
Encourage bed rest and activity restrictions.
Bed rest lessens the workload, preventing inadequate perfusion and
potential harm to the heart.
Following a cardiac catheterization, the patient should be advised not to lift
over 10 lbs or partake in strenuous activity.
AC, atrial circumflex branch;
AM, acute marginal branch;
AV, atrioventricular node;
CB, conus branch;
D1, first diagonal branch;
D2, second diagonal branch;
LAD, left anterior descending coronary artery;
LCA, left coronary artery;
LCX, left circumflex coronary artery;
OM, obtuse marginal branch;
PD, posterior descending branch;
PL, posterolateral branch;
RCA, right coronary artery;
RPD, right posterior descending branch;
RV, right ventricle;
SN, sinus node.
Age: CAD prevalence increases after 35 years of age in both men and women. The lifetime risk of developing CAD in men and women after 40 years of age is 49% and 32%, respectively.
Gender: Men are at increased risk compared to women.
Ethnicity: Blacks, Hispanics, Latinos, and Southeast Asians, are ethnic groups with an increased risk of CAD morbidity and mortality.
Family history: Family history is also a significant risk factor. Patients with a family history of premature cardiac disease younger than 50 years of age have an increased CAD mortality risk. A separate article indicated that a father or brother diagnosed with CAD before 55 years of age, and a mother or sister diagnosed before 65 years of age are considered risk factors.
Remember: you have to ask the patient about the onset (sudden or gradual), the duration, aggravators & relievers and severity (using scale from 1 - 10 or other methods). ○ We have to differentiate between stable and unstable angina by asking about if the chest pain is even at rest or only with exertion.