Disclosures. Inpatient Management of Non-ST Elevation Acute Coronary Syndromes. Edward McNulty MD, FACC. None
|
|
- Griffin Carter
- 5 years ago
- Views:
Transcription
1 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 for Non-ST Elevation MI/Unstable Angina ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST- Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. 1
2 Algorithm: Algorithm Simplified: Questions 1. Need to be an inpatient? 2. What Anticoagulation? 3. Need stress or cath? Tools 1. History/Exam 2. ECG 3. Troponin Case 1 - History 35 year old with no prior medical history reports vague chest discomfort and muscle soreness one day after lifting weights. No history of tobacco, cocaine or other illicit drug use On no meds 2
3 Case 1 - Exam BP 125/70 HR 80 sinus No signs of heart failure No signs of structural heart disease Partially reproduce symptoms with palpation/movement ECG Decision Time! Questions 1. Need to be an inpatient? 2. What Anticoagulation? 3. Need stress or cath? Tools 1. History/Exam 2. ECG 3. Troponin 3
4 Symptoms & Likelihood of MI OR (95% CI) Right arm/shoulder radiation 4.7 (1.9-12) Both arms/shoulders 4.1 ( ) Exertional 2.4 ( ) Left arm 2.3 ( ) Pressure 1.3 ( ) Pleuritic.2 (.1 -.3) Positional.3 (.2 -.5) Reproduced with palpation.3 (.2 -.4) Nitroglycerin responsive NS Swap et al JAMA 2005 ECG & in hospital mortality ST elevation 8.8% ST depression 8.5% T-wave inversion 4.9% (GUSTOIIb) Normal ECG = 1-6% chance of MI (Audience Response) The patient is admitted to your service because the chest pain unit is not operational. You decide to: (1) discharge to home right away (2) get more data 4
5 Troponin Troponin I is sent and is 2.5 ng/dl! Troponin & prognosis figure Waxman et al 2006 Case 2 - History 65 year old smoker with HTN presents with two weeks of right shoulder tightness and exertional dyspnea while playing golf. Had a mild episode after breakfast and decided to come to the ED PMHx also notable for high LDL for which he takes simvastatin in addition to aspirin 5
6 Case 2 - Exam BP 140/75 HR 90 s JVP difficult to assess Few bibasilar crackles No murmurs,s3, or S4 No edema Diminished pedal pulses bilaterally with ABI of <.9 bilaterally ECG Case 2 - Troponin Initial Troponin I is negative 6
7 Decision Time! Questions 1. Need to be an inpatient? 2. What Anticoagulation? 3. Need stress or cath? Tools 1. History/Exam 2. ECG 3. Troponin Combine tools TIMI score: Age > 65 1 History CAD 0 >2 risk factors 1 Recurrent severe angina 0 Aspirin use 1 +biomarkers 0 ST deviation 0 TIMI score and prognosis / '6/7 Death/MI/UR (%) Antman et al JAMA
8 (Audience Response) Admitted to your service. For anticoagulation you choose aspirin plus: (1) heparin (2) enoxaparin (3) one of above + eptifibatide (4) clopidogrel Anticoagulation choices, simplified aspirin aspirin + clopidogrel heparin + aspirin heparin + clopidogrel + aspirin enoxaparin + aspirin enoxaparin + clopidogrel + aspirin enoxaparin + clopidogrel heparin + eptifibatide + aspirin heparin + abciximab + aspirin enoxaparin + eptifibatide + aspirin enoxaparin + abciximab + aspirin heparin +eptifibatide +clopidogrel heparin +abciximab +clopidogrel enoxaparin + abciximab + clopidogrel enoxaparin + eptifibatide + clopidogrel bivalirudin + aspirin bivalirudin + clopidogrel bivalirudin + eptifibatide + aspirin bivalirudin + abciximab + aspirin bivalirudin + eptifibatide + clopidogrel bivalirudin + abciximab + clopidogrel (fondaparinux & permutations involving early and late clopidogrel omitted) Anticoagulation simplified, take two: Agent Heparin Pros Experience Cons Inconvenient Enoxaparin IIb/IIIa inhibitors (eptifibatide if not in or going directly to cath) Clopidogrel Bivalirudin Fondaparinux Convenient, slight advantage in higher risk patients Good in high risk pts &/or those destined for cath Convenient, helps longterm in noninvasive approach Less bleeding, may obviate need for IIb/IIIa Less bleeding? More bleeding; renal & PCI issues Bleeding, expensive Slow onset, bleeding, issues if urgent CABG needed Studied primarily in invasive context Less experience, issues with PCI 8
9 IIb/IIIa inhibitors help in Troponin+ Combined ischemic endpoint (%) Troponin - Troponin+ N=973 N=1049 Kastrati JAMA 2006 Abciximab Placebo Hospital Course Serial troponins negative No further symptoms Stress shows mild ischemia Normal EF on echo No symptoms on beta blocker discharged on clopidogrel for 9 months, lopressor, simvastatin Case 3 - History 39 year old insulin requiring diabetic presents with one month of increasing exertional dyspnea and neck discomfort with minimal exertion. One episode of pain walking from the parking lot to the VA for elective cath - admitted to telemetry 9
10 Case 3 - History PMHx Anterior MI, primary angioplasty Diabetes LDL 170 No hx HTN Meds: insulin, aspirin, acei/statin/lopressor Allergies: NTG (Viagra) No Fam Hx premature CAD No tobacco Case 3 Exam + Troponin obese, HR/BP well controlled not in CHF Cr of 4.9 (recent baseline 3-4) Troponin 3.3 ng/dl ECG new prior 10
11 Decision Time! Questions 1. Need to be an inpatient? 2. What Anticoagulation? 3. Need stress or cath? Tools 1. History/Exam 2. ECG 3. Troponin Combine tools TIMI score: Age > 65 0 Hx CAD 1 >2 risk factors 0 Recurrent severe angina 0 Aspirin use 1 +biomarkers 1 ST deviation 0 Hospital Course Started on heparin, aspirin continued. No further chest symptoms. 11
12 (Audience Response) You decide to: (1) Go to Cath (2) Stress test first, cath if high risk stress (3) D/C on meds Modern early invasive v. conservative randomized controlled studies positive RITA 3* TACTICS TIMI 18 FRISC II ISAR-COOL ICTUS negative *also late mortality advantage Higher risk patients benefit from early invasive approach Apples & Oranges conservative early inv 10 0 ICTUS RITA 3 Actual rates of revascularization, as treated 12
13 Case 3 - Angiography Patent LAD stent, restenosis in diagonal Clot in proximal RCA, distal to high grade stenosis Abciximab + heparin PCI Drug Eluting Stent with intravascular ultrasound guidance Aspirin, clopidogrel for 6-12 months Summary -Algorithms & scores don t replace clinical judgement! -Higher risk patients benefit from more aggressive anticoagulation & an early invasive approach -Future: CTA? Virtual histology? 13
14 References 2007 Guidelines for the management of non st segment MI/unstable angina (acc.org) Swap et al Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes JAMA : Waxman et al A Model for Troponin I as a Quantitative Predictor of In-Hospital Mortality JACC 2006 Goodman et al The prognostic value of the admission and predischarge electrocardiogram in acute coronary syndromes: the GUSTO-IIb ECG Core Laboratory experience. Am Heart Jor 2006 Aug;152(2): Antman et al The TIMI Risk Score for Unstable Angina/Non ST Elevation MI JAMA 2000;284: Kastrati et al Abciximab in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention After Clopidogrel Pretreatment JAMA 2006;295:
Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA
Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA Case History A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that began after
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 informationAcute Coronary Syndromes. January 9, 2013 Chris Chiles M.D. FACC
Acute Coronary Syndromes January 9, 2013 Chris Chiles M.D. FACC Disclosures None- not even a breakfast burrito from a drug company Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes* 1.57
More informationOVERVIEW ACUTE CORONARY SYNDROME SYMPTOMS 9/30/14 TYPICAL WHAT IS ACUTE CORONARY SYNDROME? SYMPTOMS, IDENTIFICATION, MANAGEMENT
OVERVIEW ACUTE CORONARY SYNDROME SYMPTOMS, IDENTIFICATION, MANAGEMENT OCTOBER 7, 2014 PETE PERAUD, MD SYMPTOMS TYPICAL ATYPICAL IDENTIFICATION EKG CARDIAC BIOMARKERS STEMI VS NON-STEMI VS USA MANAGEMENT
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 informationClinical Case. Management of ACS Based on ACC/AHA & ESC Guidelines. Clinical Case 4/22/12. UA/NSTEMI: Definition
Clinical Case Management of ACS Based on ACC/AHA & ESC Guidelines Dr Badri Paudel Mr M 75M Poorly controlled diabetic Smoker Presented on Sat 7pm Intense burning in the retrosternal area Clinical Case
More informationAn update on the management of UA / NSTEMI. Michael H. Crawford, MD
An update on the management of UA / NSTEMI Michael H. Crawford, MD New ACC/AHA Guidelines 2007 What s s new in the last 5 years CT imaging advances Ascendancy of troponin and BNP Clarification of ACEI/ARB
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 informationA Multicenter Randomized Trial of Immediate Versus Delayed Invasive Strategy in Patients with Non-ST Elevation ACS
Angioplasty to Blunt the rise Of troponin in Acute coronary syndromes Randomized for an immediate or Delayed intervention A Multicenter Randomized Trial of Immediate Versus Delayed Invasive Strategy in
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 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 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 informationUSING EVIDENCE AND GUIDELINES - TREAT YOUR PATIENTS Non-ST-segment elevation acute coronary syndrome
USING EVIDENCE AND GUIDELINES - TREAT YOUR PATIENTS Non-ST-segment elevation acute coronary syndrome Zaza Iakobishvili, MD, PhD Department of Cardiology Rabin Medical Center Petah Tikva RISK STRATIFICATION
More informationSafety of Single- Versus Multi-vessel Angioplasty for Patients with AMI and Multi-vessel CAD
Safety of Single- Versus Multi-vessel Angioplasty for Patients with AMI and Multi-vessel CAD Mun K. Hong, MD Associate Professor of Medicine Director, Cardiovascular Intervention and Research Weill Cornell
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 information(ClinicalTrials.gov ID: NCT ) Title: The Italian Elderly ACS Study Author: Stefano Savonitto. Date: 29 August 2011 Meeting: ESC congress, Paris
Early aggressive versus initially conservative strategy in elderly patients with non-st- elevation acute coronary syndrome: the Italian randomised trial (ClinicalTrials.gov ID: NCT00510185) Stefano Savonitto,
More informationTiming of Surgery After Percutaneous Coronary Intervention
Timing of Surgery After Percutaneous Coronary Intervention Deepak Talreja, MD, FACC Bayview/EVMS/Sentara Outline/Highlights Timing of elective surgery What to do with medications Stopping anti-platelet
More informationAcute Coronary Syndrome (ACS) Initial Evaluation and Management
Acute Coronary Syndrome (ACS) Initial Evaluation and Management Symptoms of Possible ACS Chest discomfort with or without radiation to the arm(s), jaw, or epigastrium Short of breath Weakness Diaphoresis
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 informationSTEMI, Non-STEMI, Chest Pain?
Minnesota Chest Pain / Acute Coronary Syndrome Tool-Kit Patient with Chest Pain Or Potential Acute Coronary Syndrome STEMI, n-stemi, Chest Pain? Follow MN STEMI Guideline Follow MN n-stemi Guideline Follow
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 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 informationCardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
More informationChest Pain: To Cath or Not? Part I
Chest Pain: To Cath or Not? Part I Georgios Papaioannou, MD Ioannis Karavas, MD Newton-Wellesley Hospital 5/3/2000 1 A Typical Scenario... 57 year old female, Mrs. X., presents to your office with a 2
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 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 informationDIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN
DIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN Objectives Gain competence in evaluating chest pain Recognize features of moderate risk unstable angina Review initial management of UA and
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 informationPreoperative Cardiac Risk Assessment: Approach & Guidelines
Preoperative Cardiac Risk Assessment: Approach & Guidelines By, Liam Morris, MD., FACC (02/03/18) CPG : Clinical Practice Guidelines GDMT : Guidelines Directed Medical Therapy GWC : Guideline Writing Committee
More informationAcute coronary syndromes
Acute coronary syndromes 1 Acute coronary syndromes Acute coronary syndromes results primarily from diminished myocardial blood flow secondary to an occlusive or partially occlusive coronary artery thrombus.
More informationPatient characteristics Intervention Comparison Length of followup
ISCHAEMIA TESTING CHAPTER TESTING FOR MYCOCARDIAL ISCHAEMIA VERSUS NOT TESTING FOR MYOCARDIAL ISCHAEMIA Ref ID: 4154 Reference Wienbergen H, Kai GA, Schiele R et al. Actual clinical practice exercise ing
More informationNSTEACS Case Presentation
NSTEACS Case Presentation Shaul Atar, MD Director of Cardiology Western Galilee Hospital Nahariya Dan Caesrea, 2010 Case Presentation 64 Y. old male HLP, HTN, smoker Prolonged typical CP at rest, multiple
More informationWhat oral antiplatelet therapy would you choose? a) ASA alone b) ASA + Clopidogrel c) ASA + Prasugrel d) ASA + Ticagrelor
76 year old female Prior Hypertension, Hyperlipidemia, Smoking On Hydrochlorothiazide, Atorvastatin New onset chest discomfort; 2 episodes in past 24 hours Heart rate 122/min; BP 170/92 mm Hg, Killip Class
More informationRecognizing the High Risk NSTEMI Patient for Early Appropriate Therapy
Recognizing the High Risk NSTEMI Patient for Early Appropriate Therapy Learning Objectives Learn to recognize the high risk patient Discuss effective management of a high risk NSTEMI patient Review CCS
More informationAcute coronary syndrome (ACS) is a potentially
DIAGNOSING ACUTE CORONARY SYNDROME AND DETERMINING PATIENT RISK Edith A. Nutescu, PharmD* ABSTRACT Acute coronary syndrome is a form of coronary artery disease and has a broad range of clinical presentations.
More informationDavid A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio
1 STABLE ISCHEMIC HEART DISEASE: A NON-INVASIVE CARDIOLOGIST S PERSECTIVE 2018 Cardiovascular Course for Trainees and Early Career Physicians APRIL 20, 2018 David A. Orsinelli, MD, FACC, FASE Professor,
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 informationManagement of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018
Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management
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 informationCardiovascular 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 informationST Elevation Myocardial Infarction
ST Elevation Myocardial Infarction Scott M. Lilly, MD, PhD Assistant Professor Clinical Department of Cardiovascular Medicine The Ohio State University Wexner Medical Center Case Presentation 46 year old
More information2007 ACC/AHA GUIDELINES FOR THE MANAGEMENT OF NSTE-ACS: OPTIMAL ANTICOAGULATION AND ANTIPLATELET THERAPY
2007 ACC/AHA GUIDELINES FOR THE MANAGEMENT OF NSTE-ACS: OPTIMAL ANTICOAGULATION AND ANTIPLATELET THERAPY Charles V. Pollack, Jr., MA, MD, FACEP, FAAEM, FAHA Professor and Chairman, Department of Emergency
More informationChoosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018
Choosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018 Choosing the Appropriate Stress Test: Does it Really Matter? Brett C. Stoll, MD, FACC February 24, 2018 Conflicts of Interest
More informationAdults With Diagnosed Diabetes
Adults With Diagnosed Diabetes 1990 No data available Less than 4% 4%-6% Above 6% Mokdad AH, et al. Diabetes Care. 2000;23(9):1278-1283. Adults With Diagnosed Diabetes 2000 4%-6% Above 6% Mokdad AH, et
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 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 informationClopidogrel and ASA after CABG for NSTEMI
Clopidogrel and ASA after CABG for NSTEMI May 17, 2007 Justin Lee Pharmacy Resident University Health Network Objectives At the end of this session, you should be able to: Explain the rationale for antiplatelet
More informationTiming of Anti-Platelet Therapy for ACS (EARLY-ACS & ACUITY) Mitchell W. Krucoff, MD, FACC
Timing of Anti-Platelet Therapy for ACS (EARLY-ACS & ACUITY) Mitchell W. Krucoff, MD, FACC Professor, Medicine/Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical
More informationST Elevation Myocardial Infarction
ST Elevation Myocardial Infarction Scott M. Lilly, MD, PhD Assistant Professor Clinical Department of Cardiovascular Medicine The Ohio State University Wexner Medical Center Outline Case Presentation STEMI
More informationISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions
Julinda Mehilli, MD Deutsches Herzzentrum Technische Universität Munich Germany ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions Background Left main
More informationDirect Thrombin Inhibitors for PCI Pharmacology: Role of Bivalirudin in High-Risk PCI
Direct Thrombin Inhibitors for PCI Pharmacology: Role of Bivalirudin in High-Risk PCI Charles A. Simonton MD, FACC, FSCAI Sanger Clinic Medical Director Clinical Innovation and Research Carolinas Heart
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 informationAcute coronary syndromes (ACS), including unstable
n report n Acute Coronary Syndromes: Morbidity, Mortality, and Pharmacoeconomic Burden Daniel M. Kolansky, MD Abstract Acute coronary syndromes (ACS), which include unstable angina and myocardial infarction
More informationM/39 CC D. => peak CKMB (12 hr later) ng/ml T.chol/TG/HDL/LDL 180/150/48/102 mg/dl #
Acute Coronary Syndrome - Case Review - Young-Guk Ko, MD Yonsei Cardiovascular Center Yonsei University College of Medicine Case 1 M/39 #4306212 CC D : Severe squeezing chest pain : 4 hours, aggravated
More informationAcute Coronary Syndromes: Selective vs Early Invasive Strategies
Acute Coronary Syndromes: Selective vs Early Invasive Strategies WilliamE.Boden,MD,FACCandVipulGupta,MBBS,MPH Division of Cardiovascular Medicine, University at Buffalo Schools of Medicine and Public Health,
More informationPathophysiology of ACS
Pathophysiology of ACS ~ 2.0 MM patients admitted to CCU or telemetry annually 0.6 MM ST-segment elevation MI 1.4 MM Non-ST-segment elevation ACS NSTEMI vs STEMI VANQWISH Boden et al N Engl J Med 1998;338:1785-1792
More informationIndications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
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 informationWhich Test When? Avoid the Stress of Stress Testing. Marc Newell, MD, FACC, FSCCT Minneapolis Heart Institute
Which Test When? Avoid the Stress of Stress Testing Marc Newell, MD, FACC, FSCCT Minneapolis Heart Institute Outline Understand the importance of coronary artery disease assessment Understand the basics
More informationTiming of angiography for high- risk ACS
Timing of angiography for high- risk ACS Christian Spaulding, MD, PhD, FESC, FACC Cardiology Department Cochin Hospital, Inserm U 970 Paris Descartes University Paris, France A very old story. The Interventional
More informationThe PAIN Pathway for the Management of Acute Coronary Syndrome
2 The PAIN Pathway for the Management of Acute Coronary Syndrome Eyal Herzog, Emad Aziz, and Mun K. Hong Acute coronary syndrome (ACS) subsumes a spectrum of clinical entities, ranging from unstable angina
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 informationSimon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine
Simon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine Research funding: American Heart Association Donaghue Foundation/ Association of American
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 informationCardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
More informationCoronary Artery Disease: Revascularization (Teacher s Guide)
Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention
More informationLessons learned From The National PCI Registry
Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients
More informationIntroduction to Risk Stratification
Introduction to Risk Stratification Tim Fendler, MD, MSc Heart Failure/Transplant Fellow St. Luke s Mid America Heart Institute 1 Disclosures: No financial relationships to disclose. A 74 year-old male
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 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 informationNew Concepts in Acute Coronary Syndromes Beyond 2000 (XX) Interactive Case Presentations
New Concepts in Acute Coronary Syndromes Beyond 2000 (XX) Interactive Case Presentations Dr. Richard Bon Surrey Memorial Hospital, Surrey, BC Canadian Cardiovascular Congress 2014 October 26, 2014 Conflicts
More informationWomen and Vascular Disease
Women and Vascular Disease KEVIN F. REBECK PA-C VASCULAR TRANSPLANT SURGERY 1 The Scope of the Problem One woman dies every minute from cardiovascular disease in the U.S.! The Scope of the Problem CVD
More informationTreatment of Acute Coronary Syndromes
Treatment of Acute Coronary Syndromes UC SF Jeffrey Tabas, M.D. sf g h Associate Professor UCSF School of Medicine Emergency Services, San Francisco General Hospital Objectives Review the updated AHA/ACC
More informationTroponin = 35. Objectives. Low Risk Chest Pain. Does this patient have ACS? Does this patient have ACS? Objectives
Objectives Low Risk Chest Pain Jeffrey Tabas, MD Professor of Emergency Medicine Office of CME UCSF School of Medicine Improve speed and accuracy in assessing patients with possible ACS! Avoid pitfalls
More informationTreatment Options for Angina
Treatment Options for Angina Interventional Cardiology Perspective Michael A. Robertson, M.D. 10/30/10 Prevalence of CAD in USA 15 million Americans with CAD 2 million diagnostic catheterizations 1 million
More informationACUTE CORONARY SYNDROME PCI IN THE ELDERLY
ACUTE CORONARY SYNDROME PCI IN THE ELDERLY G.KARABELA MD.PhD ATHENS NAVAL HOSPITAL INTERVENTIONAL CARDIOLOGY DEPARTMENT NO CONFLICT OF INTEREST TO DECLAIRE Risk stratification in Αcute Coronary Syndrome.
More informationScreening for Asymptomatic Coronary Artery Disease: When, How, and Why?
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective
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 informationNOVEL ANTI-THROMBOTIC THERAPIES FOR ACUTE CORONARY SYNDROME: DIRECT THROMBIN INHIBITORS
Judd E. Hollander, MD Professor, Clinical Research Director, Department of Emergency Medicine University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania OBJECTIVES: 1. Discuss the concept
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 informationCABG Surgery following STEMI
CABG Surgery following STEMI Susana Harrington, MS,APRN-NP Cardio-Thoracic Surgery Nebraska Methodist Hospital February 15, 2018 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction:
More informationVersion 4.4. Institutional Outcomes Report 2014Q3. National Outcomes Report Aggregation Date: Jan 12, :59:59 PM
Version 4.4 Institutional Outcomes Report 2014Q3 National Outcomes Report 999997 Aggregation Date: Jan 12, 2015 11:59:59 PM Publish Date: Jan 29, 2015 If User desires to publish or otherwise distribute
More informationClopidogrel Date: 15 July 2008
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription Sponsor/company: sanofi-aventis ClinicalTrials.gov
More informationPERIOPERATIVE MYOCARDIAL INFARCTION THE ANAESTHESIOLOGIST'S VIEW
PERIOPERATIVE MYOCARDIAL INFARCTION THE ANAESTHESIOLOGIST'S VIEW Bruce Biccard Perioperative Research Group, Department of Anaesthetics 18 June 2015 Disclosure Research funding received Medical Research
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 and bleeding risk stratification in NSTE ACS. Andrzej Budaj Postgraduate Medical School Grochowski Hospital, Warsaw, Poland
Ischemic and bleeding risk stratification in NSTE ACS Andrzej Budaj Postgraduate Medical School Grochowski Hospital, Warsaw, Poland Disclosure Andrzej Budaj, MD, PhD, reports the following potential conflicts
More informationHyeon-Cheol Gwon, On the behalf of SMART-DATE trial investigators ACC LBCT 2018
Six-month versus 12-month or longer dual antiplatelet therapy after percutaneous coronary intervention in patients with acute coronary syndromes (SMART-DATE): a randomized, openlabel, multicenter trial
More informationCurrent and Future Imaging Trends in Risk Stratification for CAD
Current and Future Imaging Trends in Risk Stratification for CAD Brian P. Griffin, MD FACC Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Disclosures: None Introduction
More information8/28/2018. Pre-op Evaluation for non cardiac surgery. A quick review from 2007!! Disclosures. John Steuter, MD. None
Pre-op Evaluation for non cardiac surgery John Steuter, MD Disclosures None A quick review from 2007!! Fliesheret al, ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and are for Noncardiac
More informationJournal of the American College of Cardiology Vol. 40, No. 6, by the American College of Cardiology Foundation ISSN /02/$22.
Journal of the American College of Cardiology Vol. 40, No. 6, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02119-8
More information10 Steps to Managing Non-ST Elevation ACS
Pathophysiology of Acute Coronary Syndromes and Potential Pharmacologic Interventions Acute Coronary Syndrome 4. Downstream from thrombus myocardial ischemia/necrosis (Beta-blockers, Nitrates etc) 3. Activation
More informationA Cardiologist s Guide to Love
A Cardiologist s Guide to Love A brief overview of what everyone should know about Palpitations, Heartache and Heartbreak! Eric J Dueweke, MD FACC Disclosure No one has yet to offer to pay me for my opinion.
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 informationCase Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?
Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized
More informationSupplementary Table 1. Details of the components of the primary composite endpoint
Supplementary Table 1. Details of the components of the primary composite endpoint 1. Death The cause of death will be defined by the underlying cause, not the immediate mode of death. Death will be classified
More informationAcute Coronary Syndromes: Challenges to Management. Claire Williams November 2017
Acute Coronary Syndromes: Challenges to Management Claire Williams November 2017 Challenge 1: Diagnosis Chest pain >20 minutes ECG Challenge 1: Diagnosis Treat as STEMI Chest pain >20 minutes ECG STEMI
More informationAdjunctive Antithrombotic for PCI. SCAI Fellows Course December 9, 2013
Adjunctive Antithrombotic for PCI SCAI Fellows Course December 9, 2013 Theodore A Bass, MD FSCAI President SCAI Professor of Medicine, University of Florida Medical Director UF Shands CV Center,Jacksonville
More informationMeasuring Natriuretic Peptides in Acute Coronary Syndromes
Measuring Natriuretic Peptides in Acute Coronary Syndromes Peter A. McCullough, MD, MPH, FACC, FACP, FAHA, FCCP Consultant Cardiologist Chief Academic and Scientific Officer St. John Providence Health
More information2018 HPN Provider Summary Guide. Adult Cardiology Patients (18 Years and Older) Referral Guidelines
12.2 CARDIOLOGY REFERRAL GUIDELINES Contracted Group: Southwest Medical Associates For Appointments: 888 S. Rancho Las Vegas, NV 89109 Phone: (702) 877-8654 Fax: (702) 242-7998 Adult Cardiology Patients
More information2/20/2013. Why use imaging in CV prevention? Update on coronary CTA in 2013 Coronary CTA for 1 0 prevention: pros and cons Are we there yet?
Evolving Role of Coronary CTA in Primary Cardiovascular Disease Prevention: Are We There Yet? Ron Blankstein, M.D., F.A.C.C. Co-Director, Cardiovascular Imaging Training Program Associate Physician, Preventive
More information