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1. ACUTE CORONARY SYNDROME DR FATIMA TARIQ

2. WHAT IS ACS? Acute coronary syndrome refers to spectrum of conditions that causes acute myocardial ischemia as blood supply to the heart muscles is suddenly blocked. It includes: 1. unstable angina 2. Myocardial infarction - STEMI, STEMI

3. PATHOPHYSIOLOGY

4. RISK FACTORS

5. How does the patient present?

6. INVESTIGATIONS

7. ECG: NSTEMI AND UNSTABLE ANGINA

8. ECG: STEMI

9. CRITERIA FOR DIAGNOSIS OF MI

10. APPROACH TO ACS

11. MANAGEMENT OF ACS Maintain IV line Oxygen therapy Pain relief: IV Morphine (5-10mg) Aspirin 300mg (then 75mg daily) Clopidogrel (Lowplat 300mg) Nitroglyerin 1 tab S/L IV Heparin -1cc (5000 units) B-blocker Abciximab (Glycoprotein IIIb/IIa inhibitor) - NSTEMI/ UA REPERFUSION THERAPY - Only in STEMI

12. PRIMARY CORONARY INTERVENTION Most effective if done within first 90 mins of cardiac event Restores patency of the vessel by implanting stent in the diseased area. After implantation of a stent, Aspirin combined with Clopidogrel for 3 to 6 months given to prevent thrombosis and restenosis.

13. REPERFUSION THERAPY Thrombolysis: Within first 20 mins of presentation to hospital. Streptokinase Tissue Plasminogen activator (tPa) eg. Altepase, Reteplase

14. RISK ASSESSMENT