Acute coronary syndrome

Acute coronary syndrome

1. ACUTE CORONARY SYNDROME

2. CORONARY ARTERY DISEASE Chronic stable Acute coronary syndrome Angina Unstable angina STEMI NSTEMI

3. Normal coronary artery

4. ANGINA PECTORIS Angina pectoris is a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest

5. PRECIPITATING FACTORS OF ANGINA Physical exertion Exposure to cold Eating a heavy meal Stress or any emotion-provoking situation Sexual activity

6. Chronic stable angina It refers to chest pain that occurs intermittently over a long period with same pattern of onset, duration and intensity of symptoms Characteristics of pain become different

7. Unstable angina also called preinfarction angina or crescendo angina symptoms occur more frequently and last longer than stable angina. The threshold for pain is lower, and pain may occur at rest.

8. Silent ischemia It refers to ischemia that occurs in the absence of any subjective symptoms Patients with diabetes have increase prevalence of silent ischemia

9. Variant angina/ Prinzmetal angina It is a varient often occurs at rest, usually in response to spasm of a major coronary artery

10. Assessment and Diagnostic Findings Exercise stress testing ST segment and T wave changes are indirect assessment of corornary perfusion Cardiac catheterisation ECG C-reactive protein (CRP ) H omocysteine

11. Medical Management objectives of the medical management of angina are to decrease the oxygen demand of the myocardium and to increase the oxygen supply . Thereby preventing MI and death

12. Nitrates Short acting Long acting MOA- dilating peripheral blood vessels dilating coronary artey and collaterals

13. Short acting- nitroglycerin- 5mg sublingually- 1 tab sublingually, Long acting- Isosorbide dinitrate , Isosorbide mononitrate

14. Beta adrenergic blockers It reduce myocardial oxygen consumption by blocking the beta-adrenergic sympathetic stimulation to the heart. The result is a reduction in heart rate, slowed conduction of an impulse through the heart, decreased blood pressure, and reduced myocardial contractility (force of contraction )

15. P ropranolol M etoprolol A tenolol

16. Calcium Channel Blocking Agents MOA- decreases the movement of calcium into membranes cardiac and arterial muscle cells Eg - N ifidipine , verapamil and diltiazem

17. Antiplatelet and Anticoagulant Medications Aspirin - Aspirin prevents platelet activation and reduces the incidence of MI and death in patients with CAD