acute coronary syndrome. quick guide 2013

Cardiovascular Association ASCARDIO-VenezuelaEuropean Society of Cardiology

Acute Cardiovascular Care Association

Acute Coronary SyndromeQuick Guide

Francisco J. Chacón-LozsánMD student UCLA-Venezuela

European Society of Cardiology: Acute Cardiovascular Care Association

LinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco

2013

Criteria for acute myocardial infarction

Criteria for prior myocardial infarction

Types

Pain Differentiation

Pain Scores

HEART score

ECG Diagnosis

Normal

Ischemia—Tall T Wave or inverted (infarction),ST segment depressed (angina)

Damage— elevated ST segment, T wave inverted.

Infraction (Acute)—Pathologic Q wave,elevated ST segment and T wave inverted.

Infarction (previous)—Pathologic Q wave,ST-T can be normal.

ECG Diagnosis

J Point

In 2 contiguous leads must have:≥ 0,25 mV in males <40 years old.≥ 0,2 mV in males >40 years old.≥ 0,15 mV females in leads V2-V3≥ 0,1 mV other leads (in absence of left ventricular hypertrophy or LBBB)

ECG Diagnosis

Ischemia Q

wave

Ischemia Q wave must have:More of 0,04sec of duration.More of 25% or R wave of amplitude.

ECG DiagnosisIschemia localization

I lateral aVR V1 septal V4 anterior

II Inferior aVL lateral

V2 septal V5 lateral

III inferior aVF inferior

V3 anterior V6 lateral

Derivation Affected Region

Coronary Lesion

V1, V2, V3 Antero-Septal Anterior Descendent

V3, V4 Anterior Anterior Descendent

V5, V6 Lower Lateral Circumflex, Right Coronary

DI, aVL Upper Lateral Diagonal, Circumflex

DII, DIII, aVF Inferior Right Coronary, Circumflex

ECG diagnosis

subendocardyum

subepicardyum

Biomarkers

Hours Days

UNSTEMI’s Management

Relieve angina using Nitrates.Patients using BB must continues using it if not Killip class >IIIUse BB in pateints with EF preserved.Calcium channel blockers are indicated in patients with nitrates and BB to relief symptoms.Use double antiplatelet theraphy:

• If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned Heparin 70U/Kg EV + Atorvastatin 80mg.

• To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned Heparin 60U/kg EV + Atorvastatin 80mg.

Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV.If not: streptokinase: 1500.000U EV in 1hr.

What to do?

Criteria for high risk with indication for invasive management

A, indicates appropriate; CTO, chronic total occlusion; I, inappropriate; Int., intervention; Med., medical; Prox. LAD, proximal left anterior descending artery; Rx, treatment; U, uncertain; and vz., vessel

What to do?

STEMI’s Management

Star the chronometer.Calm pain: consider Opioids.Reduce anxiety: consider Tranquilizer in very anxious patients.Use oxygen in patients with SaO2<95%, breathlessness or with acute heart failure.Use double antiplatelet theraphy:

• If primary PCI: Aspirin 150mg + Clopidogrel 600mg + un-fractioned Heparin 70U/Kg EV + Atorvastatin 80mg.

• To fibrinolysis: Aspirin 150mg + Clopidogrel 300mg + un-fractioned Heparin 60U/kg EV + Atorvastatin 80mg.

Preferment AtPlase: 0,75mg/kg in 30min then 0,5mg in 1hr EV.If not: streptokinase: 1500.000U EV in 1hr.

Don’t forget the chronometer!!!

References

Thanks…