Acute Coronary Syndrome


The term Acute Coronary syndrome includes clinical symptoms of unstable angina(UA) ,non-ST Segment elevation myocardial infarction (NSTEMI) and ST- Segment elevation myocardial infarction . Itoccurs due to the blood clot or atheromatous plaque forms within the coronaryartery . It causescomplete or partial blockage of the artery and ultimately narrowing of the coronary arteries and causesischemia of the heart by altering the electrical activity of the heart.

CAUSES:

It occurs due to the complete blockage of a segment of one of the coronary artery due to a thrombussuperimposed on atheromatous plaques. The sudden complete ischemia leads to necrosis ofmyocardium (HEART ATTACK) which can be salvaged by early treatment . Acute coronary syndromerepresents a shift from one category to another as new ST-elevation can develop after presentation and cardiac markers can become abnormal with recurrent ischaemic episodes such as:

The atherosclerotic lesion in unstable angina have complex morphology like ulcerated or fissured atheromatous plaques withsuperimposed plaques. Episodes of myocardial infarction are due to abrupt reduction in coronary blood flow caused by thrombosis or spasm.

NON ST -ELEVATION MYOCARDIAL INFARCTION (NSTEMI)- means unstable angina with evidence ofmyocardial damage/necrosis as evidence raised by CPK-MB or cardiac troponins.

It occurs due to occlusion of a coronary artery due to thrombosis. The thrombus is formed at the site of rupture of an atheromatous plaque in a coronary artery.

SYMPTOMS:

RISK FACTORS:

DIAGNOSIS:

EVOLUTION ofECG:

It is a valuable technique for assessing ventricular function and detecting complications such as ventricular septalis or chordae tendinae rupture producing acute mild regurgitation and pericardialeffusion.

Radionuclide blood pool scan is useful to assess ventricular function.Infarct avid scanning is possible because some isotopes., pyrophosphate are taken up byfreshly infarcted myocardium, hence, is useful in diagnosis of those patients who have non-specificECG.

TREATMENT AND MANAGEMENT:

The principal objectives of management of acute myocardial infarction are:

EARLY MEDICAL MANAGEMENT:

IN HOSPITAL TREATMENT:

myocardial infarction should be admitted directly in ICCU if facility exists., The treatment in ICCU provides necessary expertise, monitoring and resuscitation facilities.

It is a potent fibrinolytic drug but is expensive. It also prevents thromboembolic complications. It isless antigenic and does not cause hypotension. The current tPA regimen given, over 90 minutes (bolusdose of 15mg) followed by 50 mg over 30 minutes and then 35 mg over next 60 minutes) is widely accepted. The other drugs include reteplase(PA)given in double dose regimen (10 million units over 2-3

minutes followed by another dose of 10 million units after 30 minutes) andtenectaplase (TNK)given as abolus dose of 40 mg and then 0.5 mg/kg over 10 seconds.

PREVENTION / FOLLOW UP AFTER SURGERY:

COMPLICATIONS:

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