Ppt on acute coronary syndrome management

James J. Ferguson, MD The Evolving Standard of Care for Acute Coronary Syndromes 2006.

- SYNERGY Bivalirudin - ACUITY Fondaparinux - OASIS 5 “Standard” moving beyond UFH Challenges of multiple management pathways UA / NSTEMI Lessons Learned Invasive is better than conservative in high and medium risk patients / perspectives Evolving physiology Evolving data Evolving messages Putting it together The Evolving Standard of Care for Acute Coronary Syndromes 2006 Evolutionary perspectives Evolving physiology Evolving data Evolving messages Putting it together Therapeutic epochs Building on /


Is it time to ADAPT?. Background By far, the most promising of the publications to yet emerge from the ADAPT cohort – 1,974 patients evaluated for acute.

infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association Guidelines for Management and Increased Adverse Events. Ann Emerg Med. 50 2007:489-496. CrossRef | PubMed CrossRefPubMed 5/decrease the observation periods and admissions for approximately 40% of patients with suspected ACS. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study, NCT00470587; A 2 hr Accelerated Diagnostic Protocol to Assess patients with chest Pain /


Case Studies in Acute Hypertension

PMH included known CAD, CHF, and hyperlipidemia ECG performed in Triage http://mykentuckyheart.com 18 Case Study #2: Acute Coronary Syndrome Acute Anterior STE Myocardial Infarction 19 STEMI + Hypertensive Emergency Case Study #2: Acute Coronary Syndrome Physical examination: symmetrical bounding pulses, diaphoresis, and rales in both lung bases Management: ASA 325 mg Clopidogrel 600 mg Unfractionated heparin by IV infusion Nitroglycerin by IV infusion Beta-blockers are held/


โรงพยาบาลสรรพสิทธิประสงค์ อุบลราชธานี

อุบลราชธานี โรงพยาบาลสรรพสิทธิประสงค์ อุบลราชธานี How to manage ACS Complications นพ.วีระ มหาวนากูล กลุ่มงานอายุรกรรม โรงพยาบาลสรรพสิทธิประสงค์อุบลราชธานี Complications of Acute Coronary Syndrome Arrhythmic complications of ACS Mechanical complications of ACS Pump failure Right ventricular infarction Left ventricular aneurysm Left ventricular pseudoaneurysm Pericardial complications Complications involving bleeding Complications of percutaneous coronary intervention Complications of Myocardial Infarction/


After taking part in this activity, participants should be able to:

SYNERGY Trial Investigators. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA. 2004;/The SYNERGY Trial Investigators. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA. 2004;/


Claudia P. Hochberg, MD, FACC

Claudia P. Hochberg, MD, FACC Acute Coronary Syndromes - Recognition, Risk Stratification, and Management Claudia P. Hochberg, MD, FACC August 12, 2013 Topics to Cover /Courtesy of David Kandzari. Thrombus Formation and ACS UA NQMI QWMI Plaque Disruption/Fissure/Erosion Thrombus Formation Non-ST-Segment Elevation Acute Coronary Syndrome (ACS) ST-Segment Elevation Acute Coronary Syndrome (ACS) Old Terminology: New It is now recognized that unstable angina (UA), non-Q-wave myocardial infarction (NQMI/


Acute Coronary Syndrome Steven R. Bruhl MD, MS 3 rd Year Cardiology Fellow Internal Medicine Didactics July 14, 2010.

of PROVE-IT Results In patients recently hospitalized within 10 days for an acute coronary syndrome: In patients recently hospitalized within 10 days for an acute coronary syndrome:  “Intensive” high-dose LDL-C lowering (median LDL-C 62 mg/not been studied Summary ACS includes UA, NSTEMI, and STEMI ACS includes UA, NSTEMI, and STEMI Management guideline focus Management guideline focus Immediate assessment/intervention (MONA+BAH) Immediate assessment/intervention (MONA+BAH) Risk stratification (UA/NSTEMI/


Management & Nursing Care of Patient with Coronary Artery Diseases

or other forms of stress, and is promptly relieved by rest. Types of angina (Cont…) Unstable angina (Acute coronary syndrome) Unstable angina is characterized by new-onset or rapidly worsening angina, angina on minimal exertion or angina at rest/and potassium channel activators. Nitrate These drugs act directly on vascular smooth muscle to produce venous and arteriolar dilatation. Management of angina pectoris (Cont…) Beta - blockers These lower myocardial oxygen demand by reducing heart rate, BP and /


Acute Coronary Syndrome Update

stable angina. Unstable angina is considered to be an acute coronary syndrome in which there is no release of the enzymes and biomarkers of myocardial necrosis. Selecting the Appropriate Algorithm STEMI – preferred treatment in a center with PCI capability: PTCA with a target door to wire time <90 minutes. Fibrinolics are an acceptable choice Medical management for certain patient populations NSTEMI – primary PCI is/


 Decide on the correct management of patients with acute coronary syndrome based on the findings of a clinical history, examination and relevant test.

to interpret clinical findings in people presenting with acute coronary syndrome  Choose the correct evidence-based management for a number of cases of acute coronary syndrome. A 57 year old man has intermittent chest/not revascularised) (1) Prasugrel : potential advantage increased potency over clopidogrel when used in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI), especially with STEMI + who have diabetes. (2) Intravenous glycoprotein IIb/IIIa inhibitors/


Acute Coronary Syndrome and Coronary Artery Disease

Acute Coronary Syndrome and Coronary Artery Disease Garrett Preston Clark, D.O. What is ACS? Includes clinical presentations that cover the following range of diagnoses: Unstable angina Non–ST-elevation myocardial infarction (NSTEMI) ST-elevation myocardial infarction (STEMI) http://www.emedicine.com/emerg/topic31.htm What is ACS? Unstable angina & NSTEMI  unstable plaques w/ nonocclusive thrombosis STEMI  thrombotic occlusion of epicardial coronary/ in patients managed without reperfusion Tx. However/


Acute Coronary Syndrome By: Dr Tengku Abdul Kadir B Tengku Zainal Abidin Supervisor: Dr Wan Rohaidah.

to ST-elevation myocardial infarction (STEMI) depending upon the degree and acuteness of coronary occlusion. Acute coronary syndrome: Constellation of clinical symptoms compatible with acute myocardial ischemia ST-segment elevation MI (STEMI) Non-ST-segment elevation MI/ ability to detect late minor infarct BIOCHEMICAL CARDIAC MARKERS IN PTS WITH SUSPECTED ACS WITHOUT STE Management on STEMI Early management of STEMI is directed at: – Pain relief – Establishing early reperfusion – Treatment of complications/


Internal Medicine Board Review: Cardiology Acute Coronary Syndrome Christine Nardi May 20, 2009.

. Circulation 2007; 115:69–171. Incidence rate of MI has not changed but survival has Acute Coronary Syndrome Clinical syndromes caused by acute myocardial ischemia –Unstable angina Angina at rest or new onset angina, accelerating symptoms No detectable increase/angiography Early management of UA or NSTEMI includes ASA, heparin, nitrates, b-blocker, GP IIb/IIIa inhibitor, clopidogrel and statin LMWH (enoxaparin) is a suitable alternative to unfractionated heparin for patients with acute coronary syndrome or /


Zhu Jianhua M.D. 朱建华 The First Affiliated Hospital, School of Medicine, Zhejiang University Coronary Heart Disease冠心病 张力 on behalf.

Acute Myocardial Infarction Reopen the vessels Reduce the area of infarction Rescue the dying myocardium Time = Myocardium! Time = Life ! ischemia ischemic necrosis Mild impairment Moderate impairment severe impairment Best time Slightly injury Mild injured Severe injured Management/5% DES ! (2002- ) One year follow up after PCI before before after after 4 m 1 y Therapeutics Acute Coronary Syndromes-Post discharge A: Antiplatelets / ACE-I B: β- blockers / Bp control C: Cholesterol lowering (Statins) / /


Acute Coronary Syndrome Dr. S.A. moezzi ACS Overview Overview of ACS Overview of ACS Assessment of “Likelihood of ACS” Assessment of “Likelihood of ACS”

of PROVE-IT Results In patients recently hospitalized within 10 days for an acute coronary syndrome: In patients recently hospitalized within 10 days for an acute coronary syndrome:  “Intensive” high-dose LDL-C lowering (median LDL-C 62 mg/not been studied Summary ACS includes UA, NSTEMI, and STEMI ACS includes UA, NSTEMI, and STEMI Management guideline focus Management guideline focus Immediate assessment/intervention (MONA+BAH) Immediate assessment/intervention (MONA+BAH) Risk stratification (UA/NSTEMI/


Management of Coronary Artery Disease  Primary Prevention –Risk factor modification  Life style changes  Cholesterol medications – Dr. Woodruff  Management.

from coronary revascularization compared with medical therapy on survival or infarction Management of Coronary Artery Disease 1. Stable Coronary Syndromes 2. Unstable Coronary Syndromes a. Unstable Angina b. Myocardial Infarction Unstable Angina Management of Unstable Coronary Artery / but are beneficial in patients treated with mechanical reperfusion (PCI) Management of Acute Myocardial Infarction - PCI Management of Acute Myocardial Infarction A System of Medicine, 1899 Angina Pectoris Treatment: When/


Acute rheumatic fever is a non- infectious delayed complication of streptococcal sore throat due to Group A Beta hemolytic streptococcus (GABHS)

Cor pulmonale  Vasculitis (small vessels)  Atherosclerosis/ Coronary Heart disease  Dyslipoproteinemias Lymph Node and Spleen  /syndrome and ESRD. Despite the poor response to treatment, those individuals with membranous disease who develop nephrotic syndrome are treated with IV pulse cyclophosphamide and glucocorticoidscyclophosphamide Management/) – Atypical ARF – Hypersensitivity reactions – Stevens-Johnson syndrome Toxins – Mercury PHASES OF DISEASE  Acute (1-2 weeks from onset)  Febrile, irritable,/


Coronary Artery Disease &Acute Coronary Syndrome Kelly Marchant.

Cell Death is Irreversible, necrosis and scarring  Described by location of damage Acute Coronary Syndromes  Term used to describe cases of acute, prolonged ischemia that is not immediately reversible  Medical Emergency  Includes  /leading cause of death  Risk factor reduction efforts are effective but frequently nor prescribed  Aggressive Risk Factor Management antidyslipemic, antihypertensives, planned pprogram of physical activity,  Most likely to consider lifestyle changes  When hospitalized /


Acute Coronary Syndromes SIGN 93. MINAP Mortality after Acute Coronary Syndromes Cumulative: 13.6% Blue 10.6% Green 11.6% Red.

.6% Blue 10.6% Green 11.6% Red C In patients with suspected ACS, serum Troponin should be measured on arrival at hospital to guide appropriate management and treatment. C Patients with an acute coronary syndrome should be managed within a specialist cardiology service.  Patients with persisting bundle branch block or ST segment change should be given a copy of their ECG to assist future/


Cathe management of Acute Coronary Syndrome. Outline : -Objective - Statistics -Atherosclerosis -Pathophysiology -Risk factor -Acute coronary syndrome.

angina -cardiac catheterization -Use of cardiac catheterization -Technique of cardiac catheterization - Type of cardiac catheterization -Nursing intervention of cardiac catheterization -Self management after cardiac catheterization Objective : 1- Describe the pathophysiology of atherosclerosis. 2- Describe the risk factors. 3- Determine the acute coronary syndrome 4- Determine the angina and the classification of angina 5- determine the cardiac catheterization 6- describe the technique and the type/


Coronary Artery Disease. Atherosclerosis is the leading cause of death and disability in the developed and developing world Clinical manifestations depend.

scanning. Myocardial perfusion scanning. Stress echocardiography. Stress echocardiography. Coronary arteriography Coronary arteriography Management Risk factors modification such as smoking, hypertension and hyperlipidaemia. Risk/drug treatmentNitratesBeta-blockers Calcium channel antagonists Potassium channel activators Invasive treatment Percutaneous coronary intervention PCI. CABG Acute coronary syndrome Acute coronary syndrome is a term that encompasses both unstable angina and myocardial infarction /


3.17.16. Anatomy ●Arterial supply o Coronary arteries arise from?  Sinuses of Valsalva o Origin of the left and right coronary arteries?  Left= posteromedial.

atrial appendage Arterial supply ●Branches of right coronary artery? o Multiple right ventricular branches (aka acute marginal branches) o Posterior descending artery (80/acute MI ●Chronic ischemic cardiomyopathy o Develops after multiple MI’s o Most common in small vessel disease (diabetics) Treatment of CAD ●First line- lifestyle modifications and medical management/ is usually an associated leukocytosis or lymphocytosis. e.This syndrome is usually accompanied by pleural effusion and shortness of breath/


Date of download: 9/17/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2014 AHA/ACC Guideline for the Management of Patients.

infarction; and UA, unstable angina. Date of download: 9/17/2016 Copyright © The American College of Cardiology. All rights reserved. From: 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol. 2014;64(24):2645-2687/


NSTEMI Acute Coronary Syndromes

is recommended to rule out differential diagnosis Patient without recurrence of pain, normal ECG findings and negative troponins tests > non invasive stress testing NSTEMI Acute Coronary Syndromes Trends and Prognosis Diagnosis and Risk assessment Initial Management Treatment < Long-Term Management Summary of Treatment Approaches Therapeutic Options Anti-ischemic agents Anti-platelet agents ASA Clopidrogel GP IIb/IIIa Inhibitors NSTEMI Anti-coagulants UFH or LMWH Factor/


Canadian Diabetes Association Clinical Practice Guidelines Acute Coronary Syndromes and Diabetes Chapter 26 Jean-Claude Tardif, Phillipe L. L’Allier, David.

60 mg LD/ 10 mg MD CV Death / MI / Stroke ACS = Acute Coronary Syndrome; STEMI = ST-elevation Myocardial Infarction; NSTE ACS = Non-ST-elevation Acute coronary Syndrome; PCI = Percutaneous Coronary Intervention; LD = Loading Dose; MD = Maintenance Dose; NNT = Number Needed/-BANTING (226-8464) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 6 6.In-hospital management of diabetes in ACS should include strategies to avoid both hyperglycemia and hypoglycemia: – Blood glucose should be/


1. Apical Ballooning Syndrome تشخیص و افتراق سندرم قلب شکسته ارایه دهنده : الهه دلشاد استاد راهنما : جناب آقای دکتر انوشیروانی 2.

ABS has not been established, but supportive therapy invariably leads to spontaneous recovery. Because the presentation in these patients is indistinguishable from an acute coronary syndrome, initial management should be directed toward the treatment of myocardial ischemia, with continuous ECG monitoring and administration of aspirin, intravenous heparin, and -blockers. Once the diagnosis of ABS has been made, aspirin /


Epidemiology of Lipids, Lipid Management and Risk for Coronary Heart Disease:

Atherogenesis Sudden plaque rupture with overlying thrombus formation is the accepted etiology for acute coronary syndromes (ACS), including unstable angina and acute myocardial infarction (MI). Atheromatous plaque can undergo sudden transitions and rapidly progress/ transport (RCT) and a variety of antioxidative, antithrombotic, and anti-inflammatory effects along vessel walls. MANAGEMENT OF LOW HDL HDL-C can be increased in patients with dyslipidemia using statins, fibrates, niacin, thiazolidinediones/


2 This slide set was adapted from the ACC/AHA Guidelines for Management of Patients With ST- Elevation Myocardial Infarction (Journal of the American.

Before STEMI 4 123456 Onset of STEMI - Prehospital issues - Initial recognition and management in the Emergency Department (ED) - Reperfusion Hospital Management - Medications - Arrhythmias - Complications - Preparation for discharge Secondary Prevention/ Long-Term Management Presentation Working Dx ECG Cardiac Biomarker Final Dx UA NQMIQwMI No ST Elevation NSTEMI Ischemic Discomfort Acute Coronary Syndrome Unstable Angina Myocardial Infarction ST Elevation Modified from Libby. Circulation 2001;104:365/


Elsevier items and derived items © 2006 by Elsevier Inc. Coronary Artery Disease Includes stable angina pectoris and acute coronary syndromes Ischemia:

within 1 year. 29% die from MI within 5 years. 4 Hospitalizations in the U.S. Due to Acute Coronary Syndromes (ACS) Acute Coronary Syndromes* 1.57 Million Hospital Admissions - ACS UA/NSTEMI † STEMI 1.24 million Admissions per year.33 million /myocardial oxygen demand. –Increase myocardial oxygen supply. Elsevier items and derived items © 2006 by Elsevier Inc. Pain Management MONA Morphine sulfate Nitroglycerine Oxygen ASA Position of comfort; semi-Fowler’s position Quiet and calm environment Deep breaths to/


Acute Coronary Syndromes. Epidemiology Ischemic Heart Disease (IHD) is the leading cause of morbidity and mortality worldwide Ischemic Heart Disease (IHD)

Causes of chest pain Most are noncardiac and not serious Most are noncardiac and not serious Acute coronary syndrome Acute coronary syndrome Pulmonary embolism Pulmonary embolism Aortic dissection Aortic dissection Pericarditis / tamponade Pericarditis / tamponade Pneumothorax / /in ischemic episodes not responsive to other agents. ACC / AHA 2002 guidelines for management of NSTE ACS : ACC / AHA 2002 guidelines for management of NSTE ACS : Level 2A recommendation for patients without intended early cath / /


Cardiogenic Shock, Acute Coronary Syndrome, Congestive Heart Failure, and Arrhythmias Dalhousie Critical Care Lecture Series.

occlusive arterial thrombosis & ST-segment elevation MI White HD. Am J Cardiol 1997;80 (4A):2B-10B. Pathogenesis of Acute Coronary Syndromes ICU UA/NSTEMI: Partially-occlusive thrombus (primarily platelets) Intra-plaque thrombus (platelet-dominated) Plaque core STEMI: Occlusive thrombus/clinical/guidelines/unstable/unstable.pdf. http://www.acc.org/clinical/guidelines/unstable/unstable.pdf Diagnostic Algorithm for Acute Coronary Syndrome Management ICU 0.00 0.05 0.10 0.15 0.20 0.25 036912 Probability of Death/


Acute Coronary Syndrome: From Pathophysiology to Management Nasser Lakkis, MD Baylor College of Medicine Houston TX, USA.

Acute Coronary Syndrome: From Pathophysiology to Management Nasser Lakkis, MD Baylor College of Medicine Houston TX, USA STEMI Clinical finding EKG Serum/Cannon C. et al., N Engl J Med 2004; 350 (15): Epub ahead of print. How might lipid lowering improve patient outcome post- acute coronary syndromes? Plaque regression Reducing thrombogenicity Opposing vasospasm Decreasing inflammation Stabilizing fibrous cap Other Potential Therapies Antibiotics Antibiotics PROVE-IT : Gatifloxacin vs. Placebo (2 yrs) PROVE/


2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease Developed in Collaboration with.

update six guidelines: 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction 2014 ACC/AHA Guideline for the Management of Patients With Non– ST-Elevation Acute Coronary Syndromes 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery 2014 ACC/AHA/


Chapter 40 Care of Patients with Acute Coronary Syndromes Mrs. Marion Kreisel MSN, RN Adult Health 2 Fall 2011.

New-onset angina Variant (Prinzmetal’s) angina Pre-infarction angina Myocardial Infarction Most serious acute coronary syndrome Occurs when myocardial tissue is abruptly and severely deprived of oxygen Occlusion of blood flow Necrosis/ Other Procedures Arthrectomy Stents Rheolytic thrombectomy Coronary Stent Coronary Artery Bypass Graft Surgery CABG CABG (Cont’d) Preoperative care Operative procedures Postoperative care: Management of F&E balance Management of other complications— hypotension, hypothermia,/


Landmark Practice Advances In ST-Elevation Myocardial Infarction (STEMI) and Acute Coronary Syndrome (ACS) Consistent and Unified Management Strategies.

Care for High Risk ACS? Landmark Practice Advances In ST-Elevation Myocardial Infarction (STEMI) and Acute Coronary Syndrome (ACS) Consistent and Unified Management Strategies for 2008 and BeyondWhat Do New Trials Tell Us About Care for High Risk ACS? /Angelo De Gasperis Ospedale Niguarda Ca Granda Milano, Italy NSTE-ACS STEMI TROPONIN SK Landmark Practice Advances in Acute Coronary Syndromes SK+ASPIRIN r-tPA TNK Pre-H lysis Morrison PRIMARY PCI ABCIXIMAB CLOPIDOGREL REACT BIVALIRUDIN VIENNA REGISTRY CARESS /


Acute Coronary Syndromes Jason Ryan, M.D.. Acute Coronary Syndromes Unstable Angina + Non-ST-Elevation MI + ST-Elevation MI Acute Coronary Syndromes (ACS)

Acute Coronary Syndromes Jason Ryan, M.D. Acute Coronary Syndromes Unstable Angina + Non-ST-Elevation MI + ST-Elevation MI Acute Coronary Syndromes (ACS) UA + NSTEMI (life-threating but not medical emergency) STEMI (medical emergency) Acute Coronary Syndromes Generally, same symptoms for all –/planned MSO4 NTG ASA Beta Blockers Heparin Plavix IIB/IIIA Inhibitor Follow ST Protocols ACC Guidelines for Management of UA/NSTEMI American College of Cardiology (ACC) 2002 Guidelines for UA/NSTEMI Medications with /


Role of TEE in the Diagnosis in the Diagnosis of Acute Aortic Syndrome BY RAGAB Abdelsalam.(MD ) Prof.of Cardiology.

acute aortic dissection should have high sensitivity and specificity and, furthermore, permit assessment of the main anatomical and functional aspects of interest for their management. These are: - extent of the dissection. - intimal tear location. - diagnosis of complications: aortic insufficiency, principal aortic branch involvement (coronary/haematoma forms part of the acute aortic syndrome. > Aortic intramural haematoma forms part of the acute aortic syndrome. > Diagnosis by transoesophageal /


MDCT COMPLEMENTARY TO CORONARY ANGIOGRAPHY

ostial lesions: Lesions of the left main trunk (n = ) Ostial lesion of the right coronary (n = ) Ostial stenosis of the LAD Computed tomography coronary helped give a useful answer to the diagnostic management and / or therapeutic clinical situations in /14 Case 5 Male 65 years old, smoking hypertension, diabetes Admitted for acute coronary syndromes without ST segment above. The ECG and ultrasound trans chest were unremarkable/


The usual cause of an acute coronary syndrome is the rupture of an atherosclerotic plaque (Phalen and Aehlert, 2006, p. 61) Acute Coronary Syndrome.

and Tissue Injury Time is Myocardium Coronary Disease Progression Clinical Indicators of Increased Risk in UA/NSTEMI CAUSES OF ACUTE CHEST PAIN DIAGNOSTIC CONSIDERATIONS IMMEDIATE MANAGEMENT Approach to the Patient with Chest Pain Acute chest pain is one of the/ hs-C-reactive protein (prognostic)  D-dimer (PE)  B-type natriuretic peptide (HF, prognostic) Acute Coronary Syndrome Likelihood That Signs and Symptoms ST Elevation Myocardial Infarction Step 1: Assess time and risk. Time since onset of symptoms/


Metabolic Syndrome, Diabetes and Cardiovascular Disease: Strategies for Management Nathan D. Wong, PhD, FACC, FAHA Professor and Director, Heart Disease.

mg/day) and clopidogrel (75 mg/day) –Reasonable for up to a year after an acute coronary syndrome (B) ADA. VI. Prevention, Management of Complications. Diabetes Care 2013;36(suppl 1):S33-S34. United Kingdom Prospective Diabetes Study (UKPDS/in ACS and T2DM AleCardio trial Study Hypothesis: Aleglitazar, added to standard of care of pts with T2DM and recent acute coronary syndrome (ACS), would reduce cardiovascular mortality and morbidity.  phase 3  superiority trial  randomized, placebo-controlled, double/


Treatment Strategies for Women with Coronary Artery Disease Prepared for: Agency for Healthcare Research and Quality (AHRQ)

. Available at: http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and- reports/?pageaction=displayproduct&productID=1227. Acute Coronary Syndromes Acute ischemia can lead to: – Unstable angina: reversible ischemia – Non-ST elevation myocardial infarction (NSTEMI): / at: http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and- reports/?pageaction=displayproduct&productID=1227. Management of UA/NSTEMI Goals of therapy – Immediate relief of ischemia – Prevention of serious adverse outcomes/


Nephrology Mini-Symposium: Acute Cardiorenal Syndrome R3 潘思宇,R3 李宗育,R3 張凱迪,R3 柯雅琳 R5 王介立 /VS 林水龍 Nov. 24 th, 2010.

There’s Always a Problem… CASE PRESENTATION Acute Cardiorenal Syndrome Epidemiology & Pathophysiology. R3 潘思宇 Diagnosis & Management......…... R3 李宗育 Volume & Diuretics………………. R3 張凱迪 Ultrafiltration………………………. R3 柯雅琳 R5 王介立 VS 林水龍 Cardiorenal Syndrome Type I Acute heart disorder leading to acute kidney injury Acute heart disorder ? –Acute decompensated heart failure –Acute coronary syndrome –(Low cardiac output syndrome after open heart surgery) Acute kidney injury ? –ARF, Worsening renal function –AKI/


012-0400-PM 5/15 F ALLING THROUGH THE CRACKS ? E XPANDING OUR APPROACH TO ACUTE CORONARY SYNDROMES.

15 A UDIENCE RESPONSE What is your current role at your facility? Choose all that apply. 1.Nurse Manager/Director 2.Medical Director 3.Emergency Physician 4.High-level Administrator 5.Cardiologist 6.Hospitalist 7.Cardiovascular Coordinator/ /ON CHEST PAIN TESTING Adapted from Amsterdam EA, et al. Circulation 2010;122:1756-1776. SYMPTOMS SUGGESTIVE OF ACUTE CORONARY SYNDROME (ACS) Noncardiac diagnosis Treatment as indicated by alternative diagnosis Chronic stable angina See ACC/AHA Guidelines for Chronic/


Angina pectoris Angina pectoris is a clinical syndrome characterized by episodes of chest pain. It occurs when there is a deficit in myocardial oxygen.

occurred. Longer-acting nitrates are used in the prophylactic management of the angina pectoris. For prompt relief of an ongoing attack of angina precipitated by exercise or emotional stress, sublingual (or spray form) nitroglycerin is the drug of choice. Used to relieve both exertional and vasospastic angina Indications 1. Angina pectoris 2. Acute coronary syndrome (include unstable angina and non-ST segment elevation myocardial/


Acute Coronary Syndromes Prasanna Venkatesh MD Cardiology fellow LSUHSC-S.

elevation myocardial infarction (NSTEMI). Source: Adapted from Davies MJ. Pathophysiology of Acute Coronary Syndromes. Heart 2003;83:361. Stable versus Unstable Plaque UA/NSTEMI - Pathophysiology Plaque disruption or erosion Inflammation Infection /. MVO2, myocardial oxygen consumption; UA, unstable angina. Source: From Braunwald E. Unstable angina: an etiologic approach to management. Circulation 1998;98: 2219–2222, with permission. UA/NSTEMI Initial evaluation History (onset of symptoms, risk factors, h/


Acute Aortic Dissection by Abde alaziz gomaa MSc. Cardiology

Management approach : a- Initial diagnostic Steps in ER b- Initial therapeutic decisions c- Diagnostic Requirements d- Imaging modalities e- Surgical and interventional therapy 1) Essentials of diagnosis Usually middle aged or elderly hypertensive men Occasionally young patients with history of Marfan’s syndrome or other CT disorders Rarely young women in the late pregnancy or labor. Acute/a coronary ostium (usually that of the RCA). About 20% of patients with type A dissection have ECG evidence of acute /


ACC/AHA 2009 Joint STEMI/PCI Guidelines Focused Update 1 ACC/AHA 2009 STEMI/PCI Guidelines Focused Update Based on the ACC/AHA Guidelines for the Management.

Kushner ACC/AHA 2009 Joint STEMI/PCI Guidelines Focused Update 5 Hospitalizations in the U.S. Due to Acute Coronary Syndromes (ACS) Acute Coronary Syndromes* 1.57 Million Hospital Admissions - ACS UA/NSTEMI † STEMI 1.24 million Admissions per year.33 /be treated, including: –which hospitals should receive STEMI patients from EMS units capable of obtaining diagnostic ECGs –management at the initial receiving hospital, and –written criteria & agreements for expeditious transfer of patients from non-PCI-/


ACUTE CORONARY SYNDROMES R MAHARAJ EMERGENCY MEDICINE.

R MAHARAJ EMERGENCY MEDICINE LECTURE OUTLINE INTRODUCTION – EPIDEMIOLOGY/PREVALENCE/DEFINITION PATHOPHYSIOLOGY OF ACUTE CORONARY SYNDROMES APPROACH TO SUSPECTED ACUTE CORONARY SYNDROME – GUIDELINE UPDATE TREATMENT/MANAGEMENT UPDATE INTRODUCTION Coronary Artery Disease – leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality  still major cause of morbidity & burden of disease. South African perspective of cardiovascular disease: “A /


Approach to the patients with chest pain and their management Prof Dr. S. N. Ojha M.D Ph.D Principal Dr. D. Y. Patil Ayurvedic College Pune

with chest pain and their management Prof Dr. S. N. Ojha M.D Ph.D Principal Dr. D. Y. Patil Ayurvedic College Pune http://drojha.wordpress.com/ http://drojha.wordpress.com/ ACUTE MYOCARDIAL INFARCTION Defination Defination AMI/Women using OCP have increased risk of MI -Periodontal disease may be linked to coronary heart disease -Periodontal disease may be linked to coronary heart disease ECG Acute coronary syndrome ST- ElevationNo ST- Elevation CARDIAC MARKERUnstable angina - ve + ve Myocardial infarction /


Ischemic heart disease. Angina pectoris. Acute coronary syndrome. Dr. Szathmári Miklós Semmelweis University First Department of Medicine 7. Nov 2011.

– ischemic cardiomyopathy. Angina pectoris. Stable angina pectoris. Unstable angina/Non ST-elevation myocardial infarction (NSTEMI)/STEMI = acut coronary syndromes Angina pectoris Angina pectoris (Latin, angere = press or grip, pectus = chest) or stenocardia (Greek, stenos / aggravate or relieve –Associated symptoms The context of the symptom development can give clues to diagnosis and management Effort angina –Angina, which occurs predictably at a certain level of activity – stable exertional pectoris –/


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