Acute Coronary Syndromes_Unstable Angina/Non Q-Wave MI

Posted by e-Medical PPT Monday, October 8, 2012
Acute Coronary Syndromes
Unstable angina is a clinical syndrome falling between chronic angina pectoris and  myocardial infarction in the spectrum of patients with coronary artery disease (CAD)
Non Q-wave MI is a clinical syndrome falling between unstable angina and Q-wave MI

Unstable Angina
Chest pain syndrome, either new onset or progressive angina
Transient ST-segment depression on the electrocardiogram (ECG)
Without evidence of myocardial infarction by CK, CK-MB, or Troponin

Non Q-Wave MI
Chest pain syndrome, either new onset or progressive angina
Transient or persistent ST-segment depression on the electrocardiogram (ECG)
With evidence of myocardial infarction by CK, CK-MB, or Troponin

Unstable Angina/NQWMI_Pathophysiology
Acute plaque fissuring and rupture
Superimposed thrombus
Transient occlusion
Mediator-induced vasospasm may be present

Determinants of Plaque Vulnerability
Lipid-rich core size
Cap thickness
Cap inflammation and repair

Unstable Angina_Clinical Presentation
Rest angina within 1 week of presentation
New onset angina of CCSC  (Canadian) Class III or IV within 2 months of presentation
Angina increasing in CCSC Class to at least Class III or IV
Non-Q-wave myocardial infarction
Post-MI angina (>24 hours)

Unstable Angina/NQWMI_Initial Evaluation
Should take place in a medical facility, not by telephone
Careful clinical history
Physical examination
Assessment of likelihood of coronary artery disease
Assessment of risk of adverse outcomes

Electrocardiogram
One of the most important tests that can be performed is the twelve-lead ECG taken during chest pain
In the absence of ECG changes during chest pain, the diagnosis of myocardial ischemia is unlikely

CK-MB Levels
9461 patients in the PURSUIT Trial
CK-MB elevation directly correlated with mortality
Increased risk begins with CK-MB elevations just above normal levels
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