Acute coronary syndromes
|
|
- Hortense Foster
- 5 years ago
- Views:
Transcription
1 Acute coronary syndromes 1
2 Acute coronary syndromes Acute coronary syndromes results primarily from diminished myocardial blood flow secondary to an occlusive or partially occlusive coronary artery thrombus. Acute coronary syndromes are classified according to electrocardiographic changes into acute myocardial infarction (AMI) ( ST elevation and increase troponins), unstable angina (UA) ( non elevation ST and negative troponins) and non- ST elevation myocardial infarction (NSTEMI) ( increase troponins). 2
3 3
4 ACS present with similar symptoms of chest pain which is not, or only partially, relieved by GTN. ACS arises from the rupture of an unstable atheromatous plaque. This exposes the cholesterol-rich plaque in the intima to the blood, initiating platelet activation and eventual thrombus formation. 4
5 Diagnosis of acute myocardial infarction Diagnosis of AMI is based on patient history, symptoms, ECG findings &lab tests. 1- ECG ECG changes include ST segment elevation, followed by T wave inversion and Q waves development. 5
6 6
7 2- Cardiac enzymes studies: When cardiac cell is injured, enzymes are released into the circulation.the standard enzymes used for lab diagnosis of MI are : 7
8 1-Troponins: Troponins are cardiac muscle proteins which are released following myocardial cell damage and are highly sensitive and specific for myocardial infarction. It can appear in the serum within 6 hr. of infarction & stay elevated in the blood for up to 10 days. 8
9 2- Creatine kinase - MB (CK- MB): The CK-MB isoenzyme is the most specific for diagnosis. It can appear in the serum within 6 hr. of infarction & levels return to normal values within 48 hrs. 9
10 The blood is obtained from the patient at least three times, once at admission & two additional times over the next 12 to 24hrs, in order to measure troponin and CK MB. The troponin will be less sensitive to detect new myocardial damage because it would still be elevated. If early reinfarction is suspected, CK MB concentration determination is the preferred diagnostic test. 10
11 3- Lactate dehydrogenase (LDH): Appears hr. after the onset of chest pain & fall to normal in 7 days.the measurement may be helpful in patients who present with a history of chest pain that began several days before admission.in this patient CK already returned to normal before the patient is evaluated. LDH is compromised of 5 isoenzymes,the heart muscle contains LDH1. So a ratio of LDH1 / LDH2 > 1, may be helpful in distinguishing acute MI from other disorder (like liver disease, hemolysis, leukemia, pulmonary embolism & skeletal muscle disease ). 11
12 4- Aspartate transaminase (AST): Other non specific lab changes include increase in AST appears 6-12 hr. & return to normal in 3-5 days. 12
13 Treatment of acute myocardial infarction Treatment goals : 1- To relief of ischemic chest discomfort. 2-To reduce myocardial infarction by limiting the area affected. 3-To prevent coronary artery reocclusion. 4-To prevent complication, which include: CHF, arrhythmia, recurrent ischemia & reinfarction. 13
14 Pain relief Patients with suspected MI should receive sublingual GTN under tongue and oxygen therapy. Because the pain is associated with sympathetic activation, which causes vasoconstriction, increases the workload of the heart and can exacerbated the underlying conditions. If sublingual GTN fails to relieve the chest pain, IV morphine may be administered together with antiemetic such as prochlorperazine or metoclopramide. 14
15 Antiplatelet therapy An aspirin tablet chewed as soon as possible after the infarct and followed by a daily dose for at least 1 month has been shown to reduce mortality and morbidity. Thienopyridine (Clopidogrel), given in addition to aspirin, can further improve coronary artery blood flow. 15
16 Fibrinolytics It is important to open the occluded artery as quickly as possible by administering a thrombolytic agent. Fibrinolytic agents fall into tow categories: o Fibrin specific (alteplase, tenecteplase and retelpase). o fibrin non- specific (streptokinase). 16
17 They can restore blood flow in an occluded artery if administered within about 6 hrs. of the start of an attack. They cause thrombus dissolution within 30 minutes. All fibrinolytics cause haemorrhage, which may present as a stroke or a gastro-intestinal bleeding. These agents are contraindicate in patients with recent stroke, bleeds, pregnancy and surgery. Patients with exposure to streptokinase, or with history of rheumatoid fever should not receive the drug. 17
18 Unfractionted Heparin or low-molecular weight heparin (e.g. enoxaparin and dalteparin) should administered following Fibrin specific agents. Bivalirudin, a direct thrombin inhibitor, reduces reinfarction rates compared to heparin when given with streptokinase. 18
19 β- blockers : If administered early in the acute phase it may to reduce the area of infarction (limit the amount of myocardial damage ). It also decrease O2 demands &cardiac workload. Unless there are a C/I to their use B-blockers should be given to all patient having MI. ACE-Inhibitors : Useful in patients with signs of heart failure, tachycardia or a history of previous infarction. It should be started with 24 hrs. of diagnosis. Initial doses should be low then titrated as quickly as the patient tolerated. 19
20 Calcium channel blockers: Have coronary &peripheral vasodilatory action,that can elevate some of the coronary vasospasm. CCBs also effective as anti-ischemic agents,it improve coronary blood supply & reduce myocardial oxygen demand. 20
21 Complications of MI: 1-Lethal arrhythmia. 2-Congestive heart failure,mainly left ventricular failure,cause pulmonary congestion. 3-Cardiogenic shock. 21
22 Percutaneous coronary intervention PCI involves the passing of a catheter via the femoral or radial artery and aorta into the coronary vasculature under radio-contrast guidance. Inflation of a balloon at the end of the catheter in the area of the atheromatous plaques opens the lumen of the artery. 22
23 For patients undergoing PCI there is a small risk of death, myocardial infarction and longterm restenosis. This is reduced by Insertion of a coronary artery stent and the use of antiplatelet therapy. 23
24 Antiplatelet and anticoagulant therapy The goal of antiplatelet therapy for patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) is to reduce the risk of ischaemic events without increasing the risk of bleeding. 24
25 Patients undergoing primary PCI should receive aspirin and clopidogrel as early as possible. Heparin is routinely administered during the PCI procedure. Glycoprotein IIb/IIIa receptor antagonists, particularly abciximab, have been shown to reduce mortality if used during the procedure. These are used in combination with heparin, and a lower ACT ( s) is targeted to reduce bleeding complications. 25
26 Bivalirudin, a direct thrombin inhibitor, has demonstrated less bleeding compared to abciximab and may be useful in those at risk of increased bleeding. 26
Cardiovascular Disorders Lecture 3 Coronar Artery Diseases
Cardiovascular Disorders Lecture 3 Coronar Artery Diseases By Prof. El Sayed Abdel Fattah Eid Lecturer of Internal Medicine Delta University Coronary Heart Diseases It is the leading cause of death in
More informationCHAPTER-I MYOCARDIAL INFARCTION
CHAPTER-I MYOCARDIAL INFARCTION Definition A myocardial infarction, more commonly known as MI or acute myocardial infarction (AMI) or heart attack is a condition where there is interruption of blood supply
More information2010 ACLS Guidelines. Primary goals of therapy for patients
2010 ACLS Guidelines Part 10: Acute Coronary Syndrome Present : 內科 R1 鍾伯欣 Supervisor: F1 吳亮廷 991110 Primary goals of therapy for patients of ACS Reduce the amount of myocardial necrosis that occurs in
More informationMedicine Dr. Omed Lecture 2 Stable and Unstable Angina
Medicine Dr. Omed Lecture 2 Stable and Unstable Angina Risk stratification in stable angina. High Risk; *post infarct angina, *poor effort tolerance, *ischemia at low workload, *left main or three vessel
More informationObjectives. Acute Coronary Syndromes; The Nuts and Bolts. Overview. Quick quiz.. How dose the plaque start?
Objectives Acute Coronary Syndromes; The Nuts and Bolts Michael P. Gulseth, Pharm. D., BCPS Pharmacotherapy II Spring 2006 Compare and contrast pathophysiology of unstable angina (UA), non-st segment elevation
More informationAcute Coronary Syndromes
Overview Acute Coronary Syndromes Rabeea Aboufakher, MD, FACC, FSCAI Section Chief of Cardiology Altru Health System Grand Forks, ND Epidemiology Pathophysiology Clinical features and diagnosis STEMI management
More informationDiagnosis and Management of Acute Myocardial Infarction
Diagnosis and Management of Acute Myocardial Infarction Acute Myocardial Infarction (AMI) occurs as a result of prolonged myocardial ischemia Atherosclerosis leads to endothelial rupture or erosion that
More informationManagement of Acute Myocardial Infarction
Management of Acute Myocardial Infarction Prof. Hossam Kandil Professor of Cardiology Cairo University ST Elevation Acute Myocardial Infarction Aims Of Management Emergency care (Pre-hospital) Early care
More informationResults of Ischemic Heart Disease
Ischemic Heart Disease: Angina and Myocardial Infarction Ischemic heart disease; syndromes causing an imbalance between myocardial oxygen demand and supply (inadequate myocardial blood flow) related to
More informationIschemic Heart Disease
Ischemic Heart Disease Dr Rodney Itaki Lecturer Division of Pathology University of Papua New Guinea School of Medicine & Health Sciences Division of Pathology General Consideration Results from partial
More informationWhen the learner has completed this module, she/he will be able to:
Thrombolytics and Myocardial Infarction WWW.RN.ORG Reviewed September 2017, Expires September 2019 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2017
More informationAcute Coronary Syndrome. Sonny Achtchi, DO
Acute Coronary Syndrome Sonny Achtchi, DO Objectives Understand evidence based and practice based treatments for stabilization and initial management of ACS Become familiar with ACS risk stratification
More informationFastTest. You ve read the book now test yourself
FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to
More informationAcute Myocardial Infarction. Willis E. Godin D.O., FACC
Acute Myocardial Infarction Willis E. Godin D.O., FACC Acute Myocardial Infarction Definition: Decreased delivery of oxygen and nutrients to the myocardium Myocardial tissue necrosis causing irreparable
More informationQuinn Capers, IV, MD
Heart Attacks Mended Hearts Presentation, January, 2017 Quinn Capers, IV, MD Associate Professor of Medicine (Cardiovascular Medicine) Director, Transradial Coronary Interventions Division of Cardiovascular
More informationAcute Myocardial Infarction
Acute Myocardial Infarction Hafeza Shaikh, DO, FACC, RPVI Lourdes Cardiology Services Asst.Program Director, Cardiology Fellowship Associate Professor, ROWAN-SOM Acute Myocardial Infarction Definition:
More informationPractitioner Education Course
2015 Practitioner Education Course ST Elevation Myocardial Infarction 2 Pathology Concept of vulnerable plaque Mild Atheroma Diagnosis IVUS OCT 3 Diagnosis This is based on : Clinical History ECG Changes.
More informationMWLCEMS SYSTEM Continuing Education Packet Management of the Acute MI Patient
MWLCEMS SYSTEM Continuing Education Packet Management of the Acute MI Patient In this CE we will discuss the patient presenting with an acute ST-Elevation Myocardial Infarction (STEMI) Definition: Myocardial
More informationWHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply.
WHI Form - Report of Cardiovascular Outcome Ver. 6. COMMENTS To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: OMB# 095-044 Exp: 4/06 -Affix label here- Clinical Center/ID:
More informationDISCUSSION QUESTION - 1
CASE PRESENTATION 87 year old male No past history of diabetes, HTN, dyslipidemia or smoking Very active Medications: omeprazole for heart burn Admitted because of increasing retrosternal chest pressure
More informationAcute Coronary Syndrome
Acute Coronary Syndrome Clinical Manifestation of CAD Silent Ischemia/asymptomatic Stable Angina Acute Coronary Syndrome (Non- STEMI/UA and STEMI) Arrhythmias Heart Failure Sudden Death Pain patterns with
More informationAcute myocardial infarction. Cardiovascular disorders. main/0202_new 02/03/06. Search date August 2004 Nicholas Danchin and Eric Durand
main/0202_new 02/03/06 Acute myocardial infarction Search date August 2004 Nicholas Danchin and Eric Durand QUESTIONS Which treatments improve outcomes in acute myocardial infarction?...4 Which treatments
More informationMyocardial Infarction In Dr.Yahya Kiwan
Myocardial Infarction In 2007 Dr.Yahya Kiwan New Definition Of Acute Myocardial Infarction The term of myocardial infarction should be used when there is evidence of myocardial necrosis in a clinical setting
More informationContinuing Medical Education Post-Test
Continuing Medical Education Post-Test Based on the information presented in this monograph, please choose one correct response for each of the following questions or statements. Record your answers on
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Proposed Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Proposed Health Technology Appraisal Vorapaxar for the secondary prevention of atherothrombotic events after myocardial infarction Draft scope (pre-referral)
More informationHeart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United
Heart disease remains the leading cause of morbidity and mortality in industrialized nations. It accounts for nearly 40% of all deaths in the United States, totaling about 750,000 individuals annually
More informationAcute Coronary Syndrome. Emergency Department Updated Jan. 2017
Acute Coronary Syndrome Emergency Department Updated Jan. 2017 Goals and Objectives To reduce mortality and morbidity for people who have cardiovascular disease, with a focus on those who experience an
More informationAcute Coronary syndrome
Acute Coronary syndrome 7th Annual Pharmacotherapy Conference ACS Pathophysiology rupture or erosion of a vulnerable, lipidladen, atherosclerotic coronary plaque, resulting in exposure of circulating blood
More informationContinuing Medical Education Post-Test
Continuing Medical Education Post-Test Based on the information presented in this monograph, please choose one correct response for each of the following questions or statements. Record your answers on
More informationObjectives. Identify early signs and symptoms of Acute Coronary Syndrome Initiate proper protocol for ACS patient 10/2013 2
10/2013 1 Objectives Identify early signs and symptoms of Acute Coronary Syndrome Initiate proper protocol for ACS patient 10/2013 2 Purpose of this Education Module: Chest Pain Center Accreditation involves
More informationMedical Management of Acute Coronary Syndrome: The roles of a noncardiologist. Norbert Lingling D. Uy, MD Professor of Medicine UERMMMCI
Medical Management of Acute Coronary Syndrome: The roles of a noncardiologist physician Norbert Lingling D. Uy, MD Professor of Medicine UERMMMCI Outcome objectives of the discussion: At the end of the
More informationIndex. Hematol Oncol Clin N Am 19 (2005) Note: Page numbers of article titles are in boldface type.
Hematol Oncol Clin N Am 19 (2005) 203 208 Index Note: Page numbers of article titles are in boldface type. A Abciximab, as an antiplatelet agent, 93 94 Acute coronary syndromes, use of antiplatelet drugs
More informationObjectives. Treatment of ACS. Early Invasive Strategy. UA/NSTEMI General Concepts. UA/NSTEMI Initial Therapy/Antithrombotic
Objectives Treatment of ACS Michael P. Gulseth, Pharm. D., BCPS Pharmacotherapy II Spring 2006 Define early invasive strategy and what patients typically receive this approach Compare/contrast the medications
More informationMyocardial infarction
CHAPTER-I CARDIOVASCULAR SYSTEM Myocardial infarction SUB: PHARMACOTHERAPEUTICS-I CODE:T0820006 Dr. Venugopal Pharm.D Assistant Professor Department of Pharm.D Kriahna Teja Pharmacy College,Tirupati. Definition
More informationPrehospital and Hospital Care of Acute Coronary Syndrome
Ischemic Heart Diseases Prehospital and Hospital Care of Acute Coronary Syndrome JMAJ 46(8): 339 346, 2003 Katsuo KANMATSUSE* and Ikuyoshi WATANABE** * Professor, Second Internal Medicine, Nihon University,
More informationManaging IHD and acute Myocardial Infarction
Managing IHD and acute Myocardial Infarction In Ireland- 1 out of every 10 deaths ( 22% of all premature deaths) in 2006 were due to CVD 30,000 15,000 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 Source
More informationAcute myocardial infarction (AMI) and unstable angina
Part 8: Stabilization of the Patient With Acute Coronary Syndromes Acute myocardial infarction (AMI) and unstable angina (UA) are part of a spectrum of clinical disease collectively identified as acute
More information(For items 1-12, each question specifies mark one or mark all that apply.)
Form 121 - Report of Cardiovascular Outcome Ver. 9.2 COMMENTS -Affix label here- Member ID: - - To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: - Central Case No.:
More informationPost Operative Troponin Leak: David Smyth Christchurch New Zealand
Post Operative Troponin Leak: Does It Really Matter? David Smyth Christchurch New Zealand Life Was Simple Once Transmural Infarction Subendocardial Infarction But the Blood Tests Were n t Perfect Creatine
More informationFacilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction. Is it beneficial to patients?
Facilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction Is it beneficial to patients? Seung-Jea Tahk, MD. PhD. Suwon, Korea Facilitated PCI.. background Degree of coronary flow at
More informationCLINICIAN INTERVIEW RECOGNIZING ACS AND STRATIFYING RISK IN PRIMARY CARE. An interview with A. Michael Lincoff, MD, and Eric R. Bates, MD, FACC, FAHA
RECOGNIZING ACS AND STRATIFYING RISK IN PRIMARY CARE An interview with A. Michael Lincoff, MD, and Eric R. Bates, MD, FACC, FAHA Dr Lincoff is an interventional cardiologist and the Vice Chairman for Research
More informationMYOCARDIALINFARCTION. By: Kendra Fischer
MYOCARDIALINFARCTION By: Kendra Fischer Outline Definition Epidemiology Clinical Aspects Treatment Effects of Exercise Exercise Testing Exercise Rx Summary and Conclusions References Break it down MYOCARDIAL
More information2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Developed in Collaboration with American College of Emergency Physicians and Society for Cardiovascular Angiography and
More informationCangrelor: Is it the new CHAMPION for PCI? Robert Barcelona, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Intensive Care Unit November 13, 2015
Cangrelor: Is it the new CHAMPION for PCI? Robert Barcelona, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Intensive Care Unit November 13, 2015 Objectives Review the pharmacology and pharmacokinetic
More informationCardiovascular Concerns in Intermediate Care
Cardiovascular Concerns in Intermediate Care GINA ST. JEAN RN, MSN, CCRN-CSC CLINICAL NURSE EDUCATOR HEART AND & CRITICAL AND INTERMEDIATE CARE Objectives: Identify how to do a thorough assessment of the
More informationAIMS: CHEST PAIN. Causes of chest pain. Causes of chest pain: Cardiac causes: Acute coronary syndromes pericarditis thoracic aortic dissection
CHEST PAIN Dr Susan Hertzberg Emergency Department Prince of Wales Hospital AIMS: To identify causes of chest pain in patients presenting to the ED. To identify and risk stratify patients presenting with
More informationCardiac Pathology & Rehabilitation
Cardiac Pathology & Rehabilitation Which of the following best describes the physical activity performed in my leisure time? A. I perform vigorous physical activity 3X/week for 20 minutes each time B.
More informationCindy Stephens, MSN, ANP Kelly Walker, MS, ACNP Peter Cohn, MD, FACC
Cindy Stephens, MSN, ANP Kelly Walker, MS, ACNP Peter Cohn, MD, FACC Define Acute Coronary syndromes Explain the Cause Assessment, diagnosis and therapy Reperfusion for STEMI Complications to look for
More informationIschemic Postconditioning During Primary Percutaneous Coronary Intervention Mechanisms and Clinical Application Jian Liu, MD FACC FESC FSCAI Chief Phy
Ischemic Postconditioning During Primary Percutaneous Coronary Intervention Mechanisms and Clinical Application Jian Liu, MD FACC FESC FSCAI Chief Physician, Professor of Medicine Department of Cardiology,
More informationMyocardial Oxygen Supply. Ischemic Heart Disease. Autoregulation. Epidemiology of IHD. Myocardial Ischemia. Myocardial Oxygen Supply
Myocardial Oxygen Supply Ischemic Heart Disease Paul P. Dobesh, Pharm.D., BCPS St. Louis College of Pharmacy Therapeutics I Coronary blood flow coronary perfusion pressure myocardial contraction collateral
More informationST-elevation myocardial infarctions (STEMIs)
Guidelines for Treating STEMI: Case-Based Questions As many as 25% of eligible patients presenting with STEMI do not receive any form of reperfusion therapy. The ACC/AHA guidelines highlight steps to improve
More informationUpdate on Antithrombotic Therapy in Acute Coronary Syndrome
Update on Antithrombotic Therapy in Acute Coronary Syndrome Laura Tsang November 13, 2006 Objectives: By the end of this session, you should understand: The role of antithrombotics in ACS Their mechanisms
More informationLearning Objectives. Epidemiology of Acute Coronary Syndrome
Cardiovascular Update: Antiplatelet therapy in acute coronary syndromes PHILLIP WEEKS, PHARM.D., BCPS-AQ CARDIOLOGY Learning Objectives Interpret guidelines as they relate to constructing an antiplatelet
More informationSTEMI update. Vijay Krishnamoorthy M.D. Interventional Cardiology
STEMI update Vijay Krishnamoorthy M.D. Interventional Cardiology OVERVIEW Current Standard of Care in Management of STEMI Update in management of STEMI Pre-Cath Lab In the ED/Office/EMS. Cath Lab Post
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Myocardial infarction: secondary prevention in primary and secondary care for patients following a myocardial infarction 1.1
More informationUnstable angina and NSTEMI
Issue date: March 2010 Unstable angina and NSTEMI The early management of unstable angina and non-st-segment-elevation myocardial infarction This guideline updates and replaces recommendations for the
More informationIschemic heart disease
Ischemic heart disease Introduction In > 90% of cases: the cause is: reduced coronary blood flow secondary to: obstructive atherosclerotic vascular disease so most of the time it is called: coronary artery
More informationST SEGMENT ELEVATION MYOCARDIAL INFARCTION
ST SEGMENT ELEVATION MYOCARDIAL INFARCTION John Harrison, (1693-1776) H4 (1760) H1 (1737) H2 (1741) H3 (1759) In the wake of Harrison s success with H-4, legions of watch makers took up the special calling
More informationOtamixaban for non-st-segment elevation acute coronary syndrome
Otamixaban for non-st-segment elevation acute coronary syndrome September 2011 This technology summary is based on information available at the time of research and a limited literature search. It is not
More informationWhat is a myocardial infarction and how do we treat it? Paul Das Consultant Cardiologist North Wales Cardiac Centre Glan Clwyd Hospital
What is a myocardial infarction and how do we treat it? Paul Das Consultant Cardiologist North Wales Cardiac Centre Glan Clwyd Hospital What is a myocardial infarction? THEY AINT WHAT THEY USED TO BE Case
More informationAcute Coronary Syndrome. Cindy Baker, MD FACC Director Peripheral Vascular Interventions Division of Cardiovascular Medicine
Acute Coronary Syndrome Cindy Baker, MD FACC Director Peripheral Vascular Interventions Division of Cardiovascular Medicine Topics Timing is everything So many drugs to choose from What s a MINOCA? 2 Acute
More informationbivalirudin 250mg powder for concentrate for solution for injection or infusion (Angiox) SMC No. (638/10) The Medicines Company
bivalirudin 250mg powder for concentrate for solution for injection or infusion (Angiox) SMC No. (638/10) The Medicines Company 06 August 2010 The Scottish Medicines Consortium (SMC) has completed its
More informationRole of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
More informationCoronary Artery Disease & Acute Coronary Syndrome
Coronary Artery Disease & CAD & ACS Coronary Artery Disease Cardiovascular diseases are the major cause of death in the United States Heart attacks are still the leading cause of all cardiovascular disease
More informationIschemic Heart Diseases. Dr. Nabila Hamdi MD, PhD
Ischemic Heart Diseases Dr. Nabila Hamdi MD, PhD ILOs Compare and contrast the different types of angina regarding their pathogenesis, clinical manifestations and evolution. Discuss myocardial infarct,
More informationHorizon Scanning Centre November 2012
Horizon Scanning Centre November 2012 Cangrelor to reduce platelet aggregation and thrombosis in patients undergoing percutaneous coronary intervention99 SUMMARY NIHR HSC ID: 2424 This briefing is based
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
Assessment and immediate management of suspected acute coronary syndrome bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They
More informationHEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM
REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,
More informationAppendix: ACC/AHA and ESC practice guidelines
Appendix: ACC/AHA and ESC practice guidelines Definitions for guideline recommendations and level of evidence Recommendation Class I Class IIa Class IIb Class III Level of evidence Level A Level B Level
More informationGuideline for STEMI. Reperfusion at a PCI-Capable Hospital
MANSOURA. 2015 Guideline for STEMI Reperfusion at a PCI-Capable Hospital Mahmoud Yossof MANSOURA 2015 Reperfusion Therapy for Patients with STEMI *Patients with cardiogenic shock or severe heart failure
More informationCurrent Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach
Current Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach Frans Van de Werf, MD, PhD University Hospitals, Leuven, Belgium Frans Van de Werf: Disclosures Research grants
More informationNon ST Elevation-ACS. Michael W. Cammarata, MD
Non ST Elevation-ACS Michael W. Cammarata, MD Case Presentation 65 year old man PMH: CAD s/p stent in 2008 HTN HLD Presents with chest pressure, substernally and radiating to the left arm and jaw, similar
More information2018 Acute Coronary Syndrome. Robert Bender, DO, FACOI, FACC Central Maine Heart and Vascular Institute
2018 Acute Coronary Syndrome Robert Bender, DO, FACOI, FACC Central Maine Heart and Vascular Institute Definitions: Acute Myocardial Ischemia Unstable Angina Non-ST-Elevation MI (NSTEMI) }2/3 ST-Elevation
More informationAPPENDIX F: CASE REPORT FORM
APPENDIX F: CASE REPORT FORM Instruction: Complete this form to notify all ACS admissions at your centre to National Cardiovascular Disease Registry. Where check boxes are provided, check ( ) one or more
More informationCOMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP)
The European Agency for the Evaluation of Medicinal Products Evaluation of Medicines for Human Use London, 26 June 2003 COMMITTEE FOR PROPRIETARY MEDICINAL PRODUCTS (CPMP) POINTS TO CONSIDER ON THE CLINICAL
More informationOUTCOME OF THROMBOLYTIC AND NON- THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION
OUTCOME OF THROMBOLYTIC AND NON- THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION FEROZ MEMON*, LIAQUAT CHEEMA**, NAND LAL RATHI***, RAJ KUMAR***, NAZIR AHMED MEMON**** OBJECTIVE: To compare morbidity,
More informationAcute Coronary Syndrome. ACC/AHA 2002 Guidelines
Acute Coronary Syndrome ACC/AHA 2002 Guidelines ACS Unstable Angina Non ST elevation MI ST elevation MI ACS UA and Non STEMI described in these guidelines Management of STEMI described in separate guidelines
More informationManagement of acute myocardial infarction in patients presenting with ST-segment elevation
European Heart Journal (2003) 24, 28 66 Task Force Report Management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force on the Management of Acute Myocardial
More informationCHAPTER 17 Antithrombotic Agents Heparins
CHAPTER 17 Antithrombotic Agents Heparins Structure Mechanism of Action Pharmacokinetics Limitations of Unfractionated Heparin Heparin Induced Thrombocytopenia Heparin Rebound Low Molecular Weight Heparins
More informationNitroglycerin and Heparin Drip Interfacility Protocols
Nitroglycerin and Heparin Drip Interfacility Protocols EMS Protocol This protocol applies to nitroglycerin and Heparin drips that are initiated at the transferring facility prior to transport and are not
More informationSevere Coronary Vasospasm Complicated with Ventricular Tachycardia
Severe Coronary Vasospasm Complicated with Ventricular Tachycardia Göksel Acar, Serdar Fidan, Servet İzci and Anıl Avcı Kartal Koşuyolu High Specialty Education and Research Hospital, Cardiology Department,
More informationCardiac Drugs: Chapter 9 Worksheet Cardiac Agents. 1. drugs affect the rate of the heart and can either increase its rate or decrease its rate.
Complete the following. 1. drugs affect the rate of the heart and can either increase its rate or decrease its rate. 2. drugs affect the force of contraction and can be either positive or negative. 3.
More informationACS and Heart Failure
ACS and Heart Failure Jonathon Firnhaber, MD, FAAFP Associate Professor The Brody School of Medicine at East Carolina University Greenville, North Carolina Learning Objectives Establish the diagnosis and
More informationacute coronary syndromes
The immediate management of acute coronary syndromes in primary care The majority of patients who present to general practice with chest pain are unlikely to have an acute coronary syndrome. However, all
More information12 Lead EKG Chapter 4 Worksheet
Match the following using the word bank. 1. A form of arteriosclerosis in which the thickening and hardening of the vessels walls are caused by an accumulation of fatty deposits in the innermost lining
More informationST-segment Elevation Myocardial Infarction (STEMI): Optimal Antiplatelet and Anti-thrombotic Therapy in the Emergency Department
ST-segment Elevation Myocardial Infarction (STEMI): Optimal Antiplatelet and Anti-thrombotic Therapy in the Emergency Department decision-making. They have become the cornerstone of many ED protocols for
More informationAdult Acute Myocardial. Infarction
Adult Acute Myocardial Infarction Preclinical stable CAD Acute Coronary Syndrome No cardiac enzyme elevation cardiac enzyme elevation Ischemia Cell Injurydeath UA NSTEMI STEMI Definition of Coronary Artery
More informationTYPE II MI. KC ACDIS LOCAL CHAPTER March 8, 2016
TYPE II MI KC ACDIS LOCAL CHAPTER March 8, 2016 TYPE 2 MI DEFINITION: Acute coronary syndrome (ACS) encompasses a continuum of myocardial ischemia and infarction, which can make the diagnostic and coding
More informationAnticoagulants. Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT
Haemostasis Thrombosis Phases Endogenous anticoagulants Stopping blood loss Pathological formation of a haemostatic plug Arterial associated with atherosclerosis Venous blood stasis e.g. DVT Vascular Platelet
More informationDisclosures. Inpatient Management of Non-ST Elevation Acute Coronary Syndromes. Edward McNulty MD, FACC. None
Inpatient Management of Non-ST Elevation Acute Coronary Syndromes Edward McNulty MD, FACC Assistant Clinical Professor UCSF Director, SF VAMC Cardiac Catheterization Laboratory Disclosures None New Guidelines
More informationAcute Coronary Syndrome
Acute Coronary Syndrome Vik Gongidi, DO FACOI, FACC Indian River Medical Center Vero Beach, FL Slides adapted from Robert Bender, DO, FACOI, FACC Definition: Acute Myocardial Ischemia Unstable Angina Non-ST-Elevation
More informationSIGN 93 Acute coronary syndromes. A national clinical guideline Updated February Evidence
SIGN 93 Acute coronary syndromes A national clinical guideline Updated February 2013 Evidence KEY TO EVIDENCE STATEMENTS AND GRADES OF RECOMMENDATIONS LEVELS OF EVIDENCE + High quality meta-analyses, systematic
More information4. Which survey program does your facility use to get your program designated by the state?
STEMI SURVEY Please complete one survey for each TCD designation you have in your facility. There would be a maximum of three surveys completed if your facility was designated as a trauma, stroke and STEMI
More informationBelinda Green, Cardiologist, SDHB, 2016
Acute Coronary syndromes All STEMI ALL Non STEMI Unstable angina Belinda Green, Cardiologist, SDHB, 2016 Thrombus in proximal LAD Underlying pathophysiology Be very afraid for your patient Wellens
More informationNorth Wales Cardiac Network Guidelines on oral antiplatelet therapy in cardiovascular disease
Guidelines on oral antiplatelet therapy in cardiovascular disease This guidance should be considered as one part of the wider therapeutic management of patients. The indication for antiplatelet therapy
More informationThrombolysis in Cardiology to whom? Professor Steen D. Kristensen, MD, DMSc, FESC Department of Cardiology
Thrombolysis in Cardiology to whom? Professor Steen D. Kristensen, MD, DMSc, FESC Department of Cardiology UNIVERSITY OF AARHUS 1 COI Speakers fee: Aspen, AZ, Bayer, BMS/Pfizer Departmental research grant:
More informationChest pain and troponins on the acute take. J N Townend Queen Elizabeth Hospital Birmingham
Chest pain and troponins on the acute take J N Townend Queen Elizabeth Hospital Birmingham 3 rd Universal Definition of Myocardial Infarction Type 1: Spontaneous MI related to atherosclerotic plaque rupture
More informationISCHEMIC HEART DISEASE
ISCHEMIC HEART DISEASE Introduction Coronary heart disease (CHD) is the most common form of heart disease An estimated 330 000 people have a myocardial infarct each year Approximately 1.3 million people
More informationControversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
More informationQUT Digital Repository:
QUT Digital Repository: http://eprints.qut.edu.au/ This is the author s version of this journal article. Published as: Doggrell, Sheila (2010) New drugs for the treatment of coronary artery syndromes.
More information