MINI LECTURE
KELVIN NGUYEN
OBJECTIVES
Definition of ACS
UA, NSTEMI, and STEMI
Risk stratification in NSTEMI
Management
into:
Unstable Angina
Occurs at rest and prolonged, usually lasting >20
minutes
New onset angina that limits activity
Increasing angina: Pain that occurs more frequently,
lasts longer periods or is increasingly limiting the
patients activity
EKG
STEMI:
EKG
NSTEMI:
Unstable Angina:
Cardiac Enzymes
Troponin is primarily used for diagnosing MI
Age>=65
>= 3 CAD risk factors:
0-2: Low
3-4: Intermediate
risk:
Telemetry
Rule out ACS with 3 sets of troponin, EKG
Consider pre-discharge stress test
STEMI Management
STEMI patients usually go straight to the cath lab from
Cardiac monitor
Supplemental O2
Nitrates*
Beta blocker
Morphine
Clopidogrel
Aspirin
Good IV access
Call cardiology fellow!
Case
60 year old male with history of DM2 for 20 years,
References
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
www.uptodate.com:
Overview of the acute management of unstable angina and acute non-ST elevation myocardial infarction
Initial evaluation and management of suspected acute coronary syndrome in the emergency department
Criteria for the diagnosis of acute myocardial infarction