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ACS

ACS. Raj Chahal. REMEMBER... A… B… C…. History and Examination Symptom relief Investigation Treatment After care. ?Cardiac pain Haemodynamics OXYGEN if sats <94% Aim for sats of 94-98% 88-92% if COPD Remember to reassess ASPIRIN 300mg. ECG ASAP.

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ACS

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  1. ACS Raj Chahal

  2. REMEMBER... A… B… C… • History and Examination • Symptom relief • Investigation • Treatment • After care

  3. ?Cardiac pain • Haemodynamics • OXYGEN if sats <94% • Aim for sats of 94-98% • 88-92% if COPD • Remember to reassess • ASPIRIN 300mg

  4. ECG ASAP • Do not exclude ACS if initial ECG is normal • ST ELEVATION OR PRESUMED NEW LBBB • Call help & bleep chest pain specialist nurse & med reg on call. • Consideration for PRIMARY PCI AT LHCH or THROMBOLYSIS ON CCU if not for PPCI. • ST DEPRESSION OR ACUTE T WAVE INVERSION

  5. CONSIDER Ix IN CONTEXT OF Sx • TREAT AS ACS IF ABOVE ECG CHANGES. • IF NO ECG CHANGES AND IS CARDIAC SOUNDING CP FOR OVER 10 MINS THEN Ix FURTHER • ECG AND TROPONIN AT 6 HOURS AFTER WORST PAIN

  6. AT 6 HOURS • IF DYNAMIC ISCHAEMIC ECG CHANGES THEN TREAT AS ACS • IF TNT <14 THEN ACS RULED OUT • IF TNT >14 AND <100 THEN CHECK ECG AND TNT AT 12 HOURS • IF TNT >100 THEN TREAT AS ACS

  7. AT 12 HOURS COMPARE TO 6 HOUR • IF DYNAMIC ISCHAEMIC ECG CHANGES THEN TREAT AS ACS • IF <20% CHANGE IN TNT THEN ACS RULED OUT • IF >20% RISE OR FALL IN TNT THEN MODERATE RISK, TREAT AS ACS • IF >100% RISE OR >50% FALL IN TNT THEN ACUTE MI LIKELY, TREAT AS ACS

  8. ACS TREATMENT • OXYGEN (AS BEFORE) • SYMPTOM RELIEF WITH NITRATES ± OPIATES (& anti-emetic) • ASPIRIN 300mg PO stat • CLOPIDOGREL 300mg PO stat • CLEXANE (1mg/kg) SC stat

  9. ONGOING ACS TREATMENT • ASPIRIN 75mg od • Lifelong • CLOPIDOGREL 75mg od • 1/12 for STEMI; 12/12 for NSTEMI • CLEXANE 1mg/kg bd • 48 hours • BISOPROLOL 1.25mg od • NB- HR/BP/ASTHMA • RAMIPRIL 1.25mg • NB- BP/CKD • ATORVASTATIN 80mg od • 6/12

  10. REMEMBER… • PRN NITRATES / OPIATES / ANTI-EMETIC • RISK STATIFY • GRACE SCORE • RLUH RISK SCORE • HIGH RISK PATIENTS NEED URGENT CARDIOLOGY INPUT • Haemodynamically/ persistent pains / arrhythmias / heart failure

  11. ONGOING MANAGEMENT • ECHO • Heart failure management and specialist nurse input • EARLY ANGIO • TRANSFER HIGH RISK PATIENT TO LHCH FOR ANGIO ± PCI • SMOKING INTERVENTION • CARDIAC REHAB • OPD CARDIO R/V 6/52

  12. ANY QUESTIONS?

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