CAS-REPORT ACUTE CORONARY SYNDROME Dr.DINH XUAN DIEM A&E department FVH.

Slides:

Advertisements

Similar presentations

Treatment in Cardiac disease The PNs Roll Dr. Sergio Diez Alvarez Staff Specialist Physician Armidale Hospital.

Advertisements

Student’s Research Group at the Department of Internal Medicine, Hypertension and Angiology The Medical University in Warsaw PULMONARY EMBOLISM – TOUGH.

Treatment of Acute Coronary Syndrome with ST elevation ESC guidelines 2008 Dr. David Tran A&E dept. FVH 22/12/09.

Acute coronary syndrome : Risk stratification – markers of myocardial necrosis Paul Calle Emergency Department Ghent University Hospital Belgium.

Optimal Management of Hypertensive Emergency Patients: Clinical Scenarios and Panel Discussion.

Atypical Presentation of MI Johnna Walker PA-S. The case… 59 year old woman presents with chief complaint of persistent cough and chest congestion for.

Stanford ACS Guidelines 2003 David P. Lee, M.D. John S. Schroeder, M.D. *Donald Schreiber, M.D. Division of Cardiovascular Medicine and *Department of.

British Cardiac Intervention Society Risk Assessment In Acute Coronary Syndromes Dr David Newby BHF Senior Lecturer in Cardiology Associate Director of.

Chronic stable angina Dr Taban Internist & cardiologist.

Myocardial Infarction

Chest Pain Dr. Shamim Nassrally BSc (Hons) MB ChB MRCP(UK)

ECG s of patients with acute coronary syndrome Dr. David Tran A&E dept. FVH Year 2009.

DR. HANA OMER.  ANGINA PECTORIS :is a clinical syndrome characterized by paroxysmal chest pain due to transient myocardial ischemia.  It may be occur.

ACUTE CORONARY SYNDORME EARLY RISK STRATIFICATION Sarah Jamison March 2003.

Acute Chest Pain “Can I go back to sleep?” Dr. Hussam Al-Faleh Residents Course.

Acute Coronary Syndrome. Acute Coronary Syndrome (ACS) Definition of ACS Signs and symptoms of ACS Gender and age related difference in ACS Pathophysiology.

Questions for Thelma McKenzie: 1.Should it be assumed that the learners know all of the terminology, or should a glossary be included for review? 2.What.

Clinical Correlations The NYU Internal Medicine Blog A Daily Dose of Medicine

Acute Coronary Syndromes

Principles of diagnsosis of ischemic heart disease Mohammad Hashemi Interventional cardiologist Department of cardiology.

Coronary artery disease. Ischemic heart disease( coronary artery disease) Includes Stable angina Acute coronary syndromes Sudden cardiac death due to.

Enzyme Case Studies: 1 A 67 year old male two days after sustaining multiple injuries in a motor vehicle accident complains of chest pain. There is no.

‘Taxi Driver in Pain’ Tiara Gill Carrie Ross Mark Hambly.

Chest Pain Dr. Shamim Nassrally BSc (Hons) MB ChB MRCP(London) Clinical Teaching Fellow.

NYU Medical Grand Rounds Clinical Vignette Jennifer Lue, MD PGY-2 9/11/2012 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

Clinical case no. 22 Presenter: Lin,Huei-Hsiu (Caroline) (Caroline)

Coronary and Peripheral Case Work. Case 1: Acute MI( STEMI) Pt: 45 yr old Caucasian Male Several Hrs of Severe Chest pain Pt: Husband of RN Current Smoker.

Adi Kartolo University of Ottawa. Initial Presentation 42-year-old African-American male with type 2 diabetes Chief Complaint: increasing body weight.

NYU Medical Grand Rounds Clinical Vignette Audrey Pendleton, MD PGY2 November 29, 2011 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

Case #1: AMI PRESENTED BY AMI ALANIZ. Present Illness  53 year old white male  chest discomfort while playing tennis  became crushing sensation in.

CARDIOVASCULAR CARE of the OUTPATIENT Diane M. Enzweiler, MSN, ANP-BC St. Elizabeth Physicians: Heart and Vascular.

DR. ZAHOOR 1.  A 50 year old man presents to clinic with a complaint of central chest discomfort of 2 weeks’ duration, occurring after walking for more.

Case Report Pneumology Dr. David Tran A&E, FVHospital Medical meeting September 28 th, 2011.

2. Ischaemic Heart Disease.

Medical Grand Rounds Clinical Vignette October 15 th, 2008 Srikant Duggirala, M.D.

Dr Naveen K Mohan Staff grade Cardiology, D&GRI. Mr. K H 05/09/07 54 year old male Not feeling right in eve following football game in afternoon Gripping.

Drill of the Month Developed by Gloria Bizjak Recognizing and Managing Acute Coronary Syndrome.

Ischaemic Heart Disease. Aims and Objectives n Ischaemic heart disease –Definition, manifestations, epidemiology, aetiology, pathophysiology, risk factors.

Dental management of patient with cardiac disease and hypertension by:DR.SUZAN HASSAN Lecture (3).

Author: Moldovan Carmen Co-authors: Opincariu Diana Balan Daniel University of Medicine and Pharmacy Tg. Mures Cardiology Clinic, Mures Emergency Clinical.

OSCE Question 02/2015 TMH AED.

Acute Coronary Syndrome

Cardiovascular Monitoring Coronary Artery Disease.

Acute Coronary Syndromes. Learning outcomes To understand the clinical spectrum of coronary disease To recognise different presentations of the disease.

Coronary Heart Disease (CHD) László Tornóci Inst. Pathophysiology Semmelweis University.

MYOCARDIAL INFARCTION. CASE 1 Mr. A: 38 years old He smokes 1 pack of cigarettes per day He has no other past medical history 8 hours ago, he gets sharp.

>>0 >>1 >> 2 >> 3 >> 4 >> Human Diseases Presentation: Myocardial Infarction (MI) Maria Maqsood.

ACUTE ABDOMINAL PAIN Dr Ha Thi Hanh A&E. CASE REPORT Mr GRAS PAUL EUGENE 59 YO Mr GRAS PAUL EUGENE 59 YO VISIT DATE 15-DEC :10 VISIT DATE 15-DEC-2009.

ADMIRALADMIRAL Abciximab before Direct Angioplasty and Stenting in Myocardial Infarction Regarding Acute and Long term follow-up ADMIRAL Study ADMIRAL.

NYU Medical Grand Rounds Clinical Vignette Jeremy R. Beitler MD, PGY-2 December 16, 2009 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

Laboratory Testing For Cardiovascular Risk

Cardiac update for GPs - Chest pain/angina Sanjay Sastry Consultant Cardiologist Royal Bolton Hospital Royal Bolton Hospital Manchester Heart Centre Wigan.

{ Challenging Case Presentations From South Texas Methodist Hospital REGIONAL SYSTEMS OF CARE DEMONSTRATION PROJECT: MISSION: LIFELINE™ STEMI SYSTEMS ACCELERATOR.

Jeanine Romanelli, MD Paul Coady, MD Cardiologists, Lankenau Medical Center The Differences Between a Man and Woman’s Heart.

Rapid assessment of chest pain Dr Phil Avery Prince Philip Hospital Hywel Dda Health Board PCCS 18 th May 2011.

Chest Pain in the Emergency Department Junior Teaching C. Brown August 2015.

Indication Contraindication Preparation

Acute Coronary Syndrome

Prehospital NSTEMI Patient Assessment and Treatment

Sponsored by HOPE4HEALTH

CARDIOVASCULAR SYSTEM EMERGENCIES

CORONARY ARTERY DISEASE

Ischemic Heart Disease

CASE HISTORY ISCHEMIC HEART DISEASE

myocardial infraction

How would you approach this patient?

Train-the-Trainer Cases

Train-the-Trainer Cases

Train-the-Trainer Cases

Presentation transcript:

CAS-REPORT ACUTE CORONARY SYNDROME Dr.DINH XUAN DIEM A&E department FVH

 Male 54 yrs coming to A&E at 7:10 AM 17/12/2009 due to vomiting & epigastric pain  Past history : HTN, gout (irregular treatment),smoker  Medical history : Vomiting 2 times + mild epigastric pain + sweating + tired yesterday morning ( after breakfast) >> Took medicines  better. Vomiting + epigastric pain again at 2 AM this morning, more and more aggravation + very tired >> FVH at 07:10 AM

 Clinical examination : (07:20 AM) P = 80/min; BP = 160/90 mmHg; RR = 18/min T= 36.9 o C; SpO2 = 97%, W= 65kg Pain score = 4, Glasgow =15. No signs of heart, lung, abdomen. Only functional signs: Nausea, tired Mild epigastric pain, radiation to chest No dyspnea, no sweating.

TimeClinical signs paraclinical signsTreatment 7h20As above Blood tests : CBC, CRP, SGOT, SGPT, CKMB, troponine I, glycémia, créatininemia, iono, lipidémia. NS, Nexium 7h30- palpation - Left chest discomfort - Tired ECG 1 ( see next slide)- Oxygen 5l/min - Nitromint 2doses ( spray) - Plavix 75mg 4tabs (PO)

ECG 1 (07h30)

TimeClinical signsParaclinical signsTreatment 08h 2 nd left chest discomfort BP = 160/100mmHg ECG 2: see next slide- Lovenox 40mg/0.4ml 60mg (SC) ( 1mg/kg) - Aspegic 250mg/A (IV) 08h30Improvement TA= 150/85mmHg

ECG 2 (08h)

TimeClinical signs Paraclinical signsTreatment 09hBP = 160/100cmHg Troponine I = 1,02 CKMB = 208 LDH = 553, SGOT = 223 Gly = 1,98, Ct = 2,66 ECG 3 (see next slide) Echocardiography : LV kinetic trouble (-), EF = 62%, PAPs=50mmHg Chest X-ray = Cardiomegaly Abdominal US = N Cardiologist ‘s opinion : D-Dimeres, HbA1C control and hospitalization in ICU Lopril 25mg (PO)

ECG 3 (09h)

TimeClinical signs Paraclinical signsTreatment 10h30Stable situation: TA = 140/80mmHg chest discomfort (-) D-Dimer = 531 HbA1C = 6.7 consultation with dr. David >> transfered to Tam Duc hospital for further spécialized treatment.

AFFIRMATIVE DIAGNOSTIC : Non-ST elevation MI ( NSTEMI or subendocardial MI) / HTN, DM2, hypercholesterolémia. In Tam Duc hospital : Immediate coronarography >> Result :obstruction of small branch Circonflex and restricted branch of left coronary artery (70%) Disposition : medical treatment without immediate angioplasty

Remarks : Atypical AMI Risk factor : Male Smoker Diabetes HTN Family history ( Father died due to MI). Intermediate risk ( TIMI risk score = 3). Good improvement with medical treatment. Secondary angioplasty for prognostic amelioration

TIMI risk score Risk level : 1-2 : low( %) – 3-4 : intermediate( ,9%) – 5-7 : high( %) Risk factorPointsPatient Age > 65 CAD risk factors ( ≥ 3) Family histry Hypertension Current smoker High cholesterol Diabetes Known CAD ( stenosis ≥ 50%) Previous chronic use of aspirin 2 episodes of rest angina in past 24hs Elevated cardiac makers  1 ? 1