myocardial ischemia infarction stent MI coronary atherosclerosis stsemi ECG egypt Draz MY 2009

1. بسم اللله الرحمن الرحيم ACUTE CORONARY SYNDROME SIMPLE NOTES Draz MY , Egypt 2008 Mb. Bch (Tanta), D. Sc (Al azhar) .,M. Sc (Cairo) ,M. Sc (Ain shams). Surgeon ,Internist, Emergency Registrar. [email_address]

3. RISK FACTORS AND PATHOGENESIS OF ATHEROMATOUS LESIONS OF ARTERIES.

10. V.TACH.,ASYSTOLE,MASSIVE MI SUDDEN DEATH ALTERED CONDUCTION DUE TO ISCH.OR INFARCTION ARRYTHMIA MYOCARDIAL DYSFUNCTIONDUE TO INFARCTION OR ISCH. HEART FAILURE MYONECROSIS DUE TO ACUTE ISCH. MI DYNAMIC CORONARY OBSTRUCTION UNSTABLE ANGINA FIXED CORONARY ATHEROMATOUS LESION STABLE ANGINA CORONARY HEART DISEASE : CLINICAL MANIFESTATIONS AND PROBLEMS

16. ACC/AHA 2002 GUIDLINES

17. ACC/AHA 2002 GUIDLINES

18. ACC/AHA 2002 GUIDLINES

23. UNSTABLE ANGINA

24. Acute Coronary Syndrome Ischemic Discomfort Unstable Symptoms No ST-segment elevation ST-segment elevation Unstable Non-Q Q-Wave angina AMI AMI ECG Acute Reperfusion History Physical Exam

26. THROMBOSIS IN MYOCARDIAL INFARCTION SCORE FOR UNSTABLE AND NSTSMI

41. NSTSMI

49. STSEMI

68. In-stent Restenosis in small vessels treated with rotational atherectomy

72. Definite ACS Possible ACS (–) ECG; Normal biomarkers Observe; repeat ECG, markers at 4-8 hrs No recurrent pain; (–) follow-up studies Recurrent pain; (+) follow-up studies Stress test;  LV function if ischemia (–) test: outpt follow-up (+) test Admit, Use Acute Ischemia Pathway ST  Use MI Guidelines No ST  ST-T  ’s, chest pain,  markers Symptoms Suggestive of ACS

73. Emergency Room Triage of Patients with Acute Chest Pain by Means of Rapid Testing for Cardiac Troponin T or Troponin I Christian W. Hamm, M.D., Britta U. Goldmann, M.D., Christopher Heeschen, M.D., Georg Kreymann, M.D., Jürgen Berger, Ph.D., and Thomas Meinertz, M.D. NEJM,Volume 337:1648-1653, Number 23 December 4, 1997 773 consecutive patients who had had acute chest pain for less than 12 hours without ST-segment elevation on their electrocardiograms, troponin T and troponin I status (positive or negative) was determined at least twice by sensitive, qualitative bedside tests based on the use of specific monoclonal antibodies.

74. Conclusions Bedside tests for cardiac-specific troponins are highly sensitive for the early detection of myocardial-cell injury in acute coronary syndromes. Negative test results are associated with low risk and allow rapid and safe discharge of patients with an episode of acute chest pain from the emergency room. 70 =22 % 44 =94 % 123 =16 % Tn.T +VE 114 =36 % 47 =100% 171 =22% Tn.I +VE 315 47 773 NO. UNSTABLE ANGINA MI.PATIENTS TOTAL PATIENTS

75. Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. Pope ET AL. Volume 342:1163-1170, Number 16, NEJM April 20, 2000

76. Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. Pope ET AL. Volume 342:1163-1170, Number 16, NEJM April 20, 2000 55 NON CARDIAC 21 NON ISCH.CARDIAC 6 STABLE ANGINA 9 UNSTABLE ANGINA 8 MI 17 ACUTE CARDIAC ISCH. % FROM TOTAL TOTAL NO.=10,689

77. 2.3% 22 966 UNSTABLE ANGINA 2.1% 19 889 ACUTE MI % OF TOTAL DISCHARGE FROM ED NO.

78. It appears that the incidence of missed diagnoses of acute cardiac ischemia in the emergency department may be reduced by: 1- Interpreting the electrocardiogram more accurately. 2- Addressing clinical factors or preconceptions that obscure the recognition of acute myocardial infarction and unstable angina in women and nonwhite patients. 3- Considering the possibility that acute cardiac ischemia may be present in patients with chief symptoms other than chest pain. 4- Assessing recent changes in the clinical course of angina more carefully.

79. الحمد لله رب العالمين