Acute Coronary Syndromes
13 important questions on Acute Coronary Syndromes
How is the non - ST elevation ACS defined?
What are risk factors for coronary Artery disease? (11)
Hypertension
smoking
hyperlid
age
pstmeno
obesity
DM
other vascular disease
sedentary lifestyle
cocian
What is the DD of prolonged chest pain?
Aortic dissection
myocarditis
pericarditis
GI disoreder
Pulmonary disaeses
hyperventilation syndrome
aortic stenois
costochondrail pain
psychogenic pain
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What can be heart on examination during episodes of pain?
In women, and diabetic patients ACS should be considered in?
New left bunlde branche block
What is characteristic of NOT-ST elevation ACS on the ECG?
How is the treatment algorithm in NON - ST -elevation ACS
analgesic: morphine
Antiplatel: aspirin + clopidogrel or ticagrelor
Anti coagulant: Heparin ( LMWH)
Consider PCI during RISK stratification.
Beta blokker should be started in 24 hours without any contra indications ( after stabilization).
ACE <24 hours if systloic >100
What are the contra indications to b blocker use in ACS?
> moderate left ventricular dysfuncitoin
shock or increased risk of cardiogenic shock
AV block ( 1e degree ) PR >0.24 sec
Systolic < 90
active Asthma or COPD
What are the high risk indicators for an early invasive approach in non -ST elevation ACS?
recurrent angina at rest
hemodynamic instability
heart failure
worsening mitral regurgitation
VT or VF
High TIMI or GRACE score
New ST-segment depression?
What does s4 sound indicate?
What is indicated in an inferior STEMI to determine ST-segment elevation?
What is the treatment of cardiogenic shock?
In the case of inadequate CO --> dobutamine.
< 90 and low CO --> norepinephrine to raise RR, later dobutamine can be added and to reduce the dosage of norepineprhine
How can you treed AV block I and II first degree?
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