ACS

Acute coronary syndrome

includes all syndromes compatible with acute myocardial ischemia resulting from imbalance between myocardial oxygen demand and supply.

ACS

Atherosclerosis may often lead to

Atherosclerosis

accumulation of fats in our blood vessels

Ischemia

loss of oxygen and is reversible

infarction

tissue death and is irreversible

1. ST segment elevation myocardial infarction

2. Non ST segment elevation ACS

2 types of ACS

ACS

there is an imbalance in he oxygen supply and main demand

NSTMI

unstable angina

2 classifications of NSTE ACS

tunica intima

the innermost layer of a blood vessel

tunica intima

uncontrolled fats goes here

tunica media

The middle and thickest layer of tissue of a blood vessel wall

tunica media

oxidized fats are stored here

tunica adventitia

outer layer of blood vessel

Right coronary artery

supplies to the posterior wall, septum and capillary muscles

30-40%

cases of MI caused by Right coronary artery

left circumflex artery

Supplies blood to the lateral walls of the LEFT ventricle, the LEFT atrium and in 50% of the population, to the SA node. It also supplies blood to the LEFT posterior fasciculus of the left bundle branch. This artery circles the LEFT ventricle and provides blood to the ventricle's posterior portion.

15-25%

case of left circumflex artery

left anterior artery

worst

suppplies the oxygen to the anterior and septum as well

left anterior artery

most common cause of MI

40-50%

cases of MI caused by left anterior artery

Endocardium

myocardium

Epicardium

parts of left anterior artery

subendocardial infarction

death of tissue that does not extend through the full thickness of the myocardial wall

20-40 minutes ischemia

involves endocardium+1/3 myocardium

3-6 hrs of ischemia

extension of ischemia or "transmural infarct"

creatine

result of muscle metabolism

3-5 hrs

after onset of pain of CKMB

48-72 HRS

when does the CKMB will return to baseline

Troponin T and I

more specific and sensitive than CKMB

endothelial dysfunction,

inflammation and formation of fatty streaks

they contribute to development of atherosclerotic coronary artery plaques

type 1

subtype of MI that has rupture, fissure or erosion of an atherosclerotic plqaue (90% of cases)

type2

subtype of MI that has reduced myocardial oxygen supply or increased demnd in the absence of a coronary artery process

type 3

subtype of MI wherein the MI resulting in drath without possibility of measuring biomakers

type 4

subtype of MI wherein MI associated with precutaneous coronary intervention or stent thrombosis

type 5

subtype of MI wherein MI associated with coronary artery bypass graft surgery

ejection fraction

the amount of blood being pushed from LV going to aorta

LV dilation

REDUCED PUMPING FUNCTION

ventricukar remodeling after MI is characterized by

midline anterior chest pain

predominant symptom of ACS

referred pain

The phenomenon of pain in the stomach when the problem is in the heart is called

decompensated heart failure

not enough oxygen that is distribited in our body

when troponin T or I rise or fall

diagnosis of MI is confirmed using?

atorvastatin and rosuvastatin

2 agents for hugh intensity statin

fibrinolytic therapy

indicated in patients with STEMI who present within 12 hrs of the onset of chest discomfort to a hospital not capable of primary PCI

alteplase

reteplase

tenecteplase

streptokinase

fibrinolytics examples

intracranial hemorrhage

most serious ADR of fibrinolytics

non-enteric coated aspirin 162-325 mg

if px STEMI is active give_ at_mg

75-165 mg

maintenance dose of aspirin

clopidogrel, prasugrel, ticagrelor

oral platelet P2Y12 inhibitors examples

Cangrelor

IV platelet P2Y12 inhibitors examples

ADP inhibitor+Aspirin

this drug is recommended for all STEMI px

GPI

Blocks the final common pathway of platelet aggregation, namely cross linking of platelets by fibrinogen bridges between the GP IIb and IIIa receptors on the platelet surface

Abciximab, eptifibatide, tirofiban,fondaparinux

Glycoprotein IIb/IIIa inhibitors

UFH ir bivalirudin

anticoagulants tha is preferred for px undergoing primary PCI

B-adrenergic blockers

decreases oxygen demand in heart

metoprolol, bisoprolol and carvedilol

beta blockers used for heart failure

Venodilation

nitroglycerin cases_which lowers preload and myocardial oxygen

CCB

after STEMI, these are used for relief of ischemic symptoms in px who have CI to b-blockers