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PRESENTATION
Conclusion
(08/10/2018) :
1. Cor is not valid
2. Pulmo shows no
abnormality
DIAGNOSIS
Ax : Unstable Angina Pectoris dd NSTEMI
Fx : Killip 1
Ex : PJK
Fx : Killip 1
Ex : PJK
Fx : Killip 1, EF 43-47%
Ex : PJK
Chest pain
GI Musculoskeletal
• Oesophageal spasm • Costochondriasis
• GORD • Trauma
• Pancreatitis
Diagnosis
Presenting symptoms
• The presence of substernal chest pain
• Discomfort provoked by exertion or
emotional stress
• Relieved by rest and/or nitroglycerin
ECG abnormalities
UA NSTEMI STEMI
Normal troponin Raised troponin Raised troponin
* ECG normal * ST depression * ST elevation
* Possible ST * Can be normal * Hyperacute T waves
depression * Possible T wave * New LBBB
inversion * T inversion (hours)
* Q waves (days)
Division of Cardiology
Management
A Patent?
B Oxygen (aim for sats 94-98%), auscultate, RR
C IV access (+/-fluids), HR, BP
D GCS, pupils, cap blood glucose
E Expose
Treatment
• β blocker
Anti-ischemic • Nitrates
therapies • +/- calcium antagonist
Adjunctive • Statin
therapies • ACE inhibitor
STEMI
• TIME IS IMPORTANT
• Percutaneous coronary intervention (Primary PCI)
– ‘Call to balloon time’ of 120 minutes
– Requires clopidogrel 600mg loading dose
• Thrombolysis
– Streptokinase / alteplase / tenecteplase…
– Contraindications
– Clopidogrel 600mg loading dose AND LMWH
• Beta blocker i.e. Atenolol
• ACE inhibitor i.e. Lisinopril
Longer-term management
• Continuous ECG monitoring as inpatient/ CCU
• Aspirin 75mg OD (lifelong)
• Clopidogrel 75mg (1 year)
• Beta blocker (1 year - lifelong)
• ACE inhibitor
• Statin
• Modification of risk factors
Complications
Early <72hr Late
• Death • Ventricular wall rupture
• Cardiogenic shock • Valvular regurgitation
• Heart failure • Ventricular aneurysms
• Ventricular arrhythmia • Cardiac tamponade
• Myocardial rupture • Dresslers syndrome
• Thromboembolism • Thromboembolism
Complication Mechanisms
Hipertension
Definition
• Hypertension is defined as office SBP values ≥140 mmHg
and/or diastolic BP (DBP) values ≥90 mmHg.
Classification
Factors influencing cardiovascular risk in patients
with hypertension
Characteristics of hypertensionmediated
organ damage