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BLT- Acute Coronary Syndromes

Dr Stevan C. Wing discusses Acute Coronary Syndromes (Barts and The London 2011)

Stevan Wing

on 26 September 2011

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Transcript of BLT- Acute Coronary Syndromes

Acute coronary syndrome Stevan Wing Inflammation Abnormal lipid metabolism Thrombosis A B C Atheromatous plaque Bursts Clot forms ACS 0..................10....................20....................30....................40....................50...... //......12hrs NSTE-ACS

STEMI UA NSTEMI Reduction in coronary blood flow Clinical features History Examiation Chest pain S.O.C.R.A.T.E.S. Onset Characteristic Radiation Site Associations Timing Exacerbating and relieving factors Severity Initial Mx ECG! Assess likelihood
Support diagnosis
Exclude differentials
Elucidate circumstances
Define context 1. Support diagnosis
2. Exclude differentials
3. Identify complications MONA MOVE Monitor


Venous access

ECG Morphine (antiemetic)



Aspirin Within 10 minutes
Determines management STEMI NSTE-ACS Needs URGENT reperfusion Time is muscle Primary Percutaneous Coronary Intervention Thrombolysis if not available Up to 12 hours post onset Follow local protocols Admit to acute care Aspirin
Anticoagulate (enoxaparin/fondaparinux)
Statin Monitoring Risk stratify Review High risk Intermediate/low risk Cardiac enzymes Review If pain not settling NSTEMI Unstable angina GTN infusion
?early ACEi STOP thrombosis REDUCE myocardial O2 demand Thanks Stevan Wing Acute coronary syndrome A practical approach Some coronary anatomy... Complications of myocardial infarction 1. Have a system
2. Know the most common Davies, Thomas
Heart 1985 Reimer, Lowe,
Rasmussen, Jennings
Circulation 1977 Many thanks Prof. Timmis Many thanks Prof. Timmis Many thanks Prof. Timmis Many thanks Prof. Timmis http://bit.ly/Dr-Wing-ACS
Full transcript