ACS(acute_coronary_syndrome)_CBL_case_based_learning.pptx

The presentation speaks about a typical presentation of a patient of acute coronary syndrome.
Differential diagnosis.
Chest xray findings
Acute markers of Myocardial infarction.

1. Acute Coronary Syndrome (ACS) – A Case-Based Learning Approach Presented by: [Your Name] Institution/Department: [Your Institution]

2. Case Presentation 🔹 **Age/Gender:** 55-year-old male 🔹 **Symptoms:** Retrosternal chest pain radiating to left arm, sweating, nausea 🔹 **Vitals:** BP: 140/90 mmHg, HR: 98 bpm, RR: 20/min, SpO₂: 96% 🔹 **Examination:** Normal S1S2, no murmurs, mild basal crepts 🖼 *ECG Placeholder: ST-elevation in leads II, III, aVF*

3. Differential Diagnosis 📌 **Possible Diagnoses:** ✔ **Cardiac:** STEMI, NSTEMI, Unstable Angina, Myocarditis ✔ **Respiratory:** Pulmonary embolism, Pneumothorax ✔ **Gastrointestinal:** GERD, Esophageal spasm ✔ **Musculoskeletal:** Costochondritis 📊 *Flowchart Placeholder for Diagnosis Approach*

4. Chest X-ray Findings ✔ To rule out pulmonary causes ✔ Expected in ACS: **Normal or mild pulmonary congestion** ✔ Differential: Cardiomegaly (CHF), Widened mediastinum (Aortic dissection) 🖼 *Placeholder for Normal vs. ACS X-ray*

5. Biomarkers of Acute MI 📊 **Biomarker Trends:** | Marker | Onset | Peak | Duration | Clinical Use | |---------|--------|-------|-----------|--------------| | Troponin I/T | 2-4 hrs | 24 hrs | 7-10 days | Gold standard | | CK-MB | 4-6 hrs | 12-24 hrs | 48-72 hrs | Reinfarction detection | | Myoglobin | 1-2 hrs | 6-12 hrs | 24 hrs | Early marker, non-specific | 🖼 *Graph showing Troponin vs CK-MB vs Myoglobin trends*

6. Initial Management (MONA Protocol) 📌 **MONA Management:** ✔ **Morphine:** For pain relief (Use cautiously in hypotension) ✔ **Oxygen:** Only if SpO₂ < 90% ✔ **Nitroglycerin:** Sublingual (Avoid in RV infarction) ✔ **Aspirin:** 325 mg chewable 🖼 *Algorithm for Initial ACS Management*

7. Anti-Platelet & Statin Therapy ✔ **Aspirin:** 75-325 mg/day lifelong ✔ **Clopidogrel/Prasugrel/Ticagrelor:** Dual therapy for at least 1 year ✔ **Statins (High intensity):** Atorvastatin 40-80 mg 🖼 *Table comparing Aspirin, Clopidogrel, Ticagrelor*

8. Reperfusion Therapy (PCI) ✔ **Primary PCI within 90 min if available** ✔ **If PCI unavailable:** Thrombolysis within 30 min ✔ **Contraindications:** Late presentation, bleeding disorders 🖼 *Image Placeholder: Coronary Angioplasty*

9. Thrombolytic Therapy 📌 **Fibrinolytics Used in STEMI:** | Drug | Dose | Route | |-------|------|-------| | Streptokinase | 1.5 million U | IV | | Alteplase (tPA) | 15 mg bolus + Infusion | IV | | Tenecteplase | Weight-based bolus | IV | 🖼 *Thrombolysis vs PCI Outcomes*

10. Anticoagulation Therapy ✔ **Heparin:** Unfractionated Heparin (UFH) or LMWH ✔ **Fondaparinux:** Better for NSTEMI ✔ **Duration:** STEMI: 2-8 days, NSTEMI: 48 hrs 📊 *Table comparing Heparin, LMWH, Fondaparinux*

11. Anti-Anginal Therapy 📌 **Drugs Used:** | Class | Example | |--------|----------| | Nitrates | Nitroglycerin | | Beta-blockers | Metoprolol | | CCBs | Diltiazem | | Ranolazine | Used in refractory angina | 🖼 *Graph: Effect of Anti-anginals on HR & BP*

12. Renin-Angiotensin Blockade ✔ **ACE Inhibitors (Lisinopril, Ramipril):** Reduce mortality in STEMI ✔ **ARBs (Losartan, Valsartan):** Alternative in ACE intolerance ✔ **Contraindicated in:** Hypotension, bilateral renal artery stenosis

13. Echocardiographic Findings ✔ **Wall motion abnormalities:** Hypokinesia, Akinesia ✔ **LV dysfunction:** Reduced EF (<40%) ✔ **Complications:** Ventricular aneurysm, MR 🖼 *ECHO showing RWMA*

14. Lipid-Lowering Therapy ✔ **Statins (High-intensity):** Atorvastatin 40-80 mg, Rosuvastatin 20-40 mg ✔ **LDL Target:** <55 mg/dL in high-risk patients

15. Lifestyle Modifications ✔ **Smoking cessation:** Nicotine replacement, counseling ✔ **Diet:** Mediterranean diet, low saturated fat ✔ **Exercise:** 150 min/week moderate activity ✔ **BP & DM Control:** Target BP <130/80 mmHg

16. Rehabilitation & Discharge Advice 📌 **Cardiac Rehab:** ✔ **Early Mobilization:** Within 24-48 hrs post-MI ✔ **Return to Work:** 2-6 weeks based on severity ✔ **Medications:** Lifelong adherence to secondary prevention 🖼 *Cardiac Rehab Stages*

17. Conclusion ✅ **Key Takeaways:** ✔ Early recognition & treatment improves survival ✔ PCI preferred; thrombolysis in unavailable settings ✔ Long-term lifestyle & medication adherence essential

18. References 📚 Harrison’s Internal Medicine, Braunwald’s Cardiology 📚 ACC/AHA STEMI & NSTEMI Guidelines 2024