Acute Coronary syndromes. Yael Moussadji Aug 21, 2008. Objectives. Diagnosis of ACS in the ED Risk Stratification Cardiac markers ECG Risk Scores Management UA/NSTEMI STEMI Complications. Pathophysiology. Definitions. Case 1.
Aug 21, 2008
Are cardiac risk factors useful in evaluating the risk of ACS?
How useful are clinical features in the diagnosis of acute, undifferentiated chest pain?
What is the predictive and prognostic value of the ECG in patients with ACS?
CM Gibson 2002
So, if risk factors, clinical features, and ECG’s are not always helpful, how many patient’s with ACS are missed, and what are their characteristics?
Can you diagnose ACS based on an elevated TnT in a patient with renal failure?
Should all patients with ACS (UA/NSTEMI/STEMI) get plavix?
Should we give this patient (NSTEMI) UFH or LMWH? What if they are over 75 years of age? Or have renal failure? Or have a STEMI?
Cochrane Database of Systematic Reviews 2003
Should we give this patient (or all patients with ACS) beta blockers?
Effect of fibrinolysis on 35 d mortality
Boersma et al. Lancet 1996;348:771
Do you give this patient lytics, or do you wait an hour for the cath lab?
What are the complications of an MI?
THE END! emergency revascularization within 6 hours (angioplasty, CABG, +/- IABP) or medical stabilization (+/- lytics, +/- IABP)