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Acute Coronary Syndromes: A Comprehensive Guide for Medical Professionals, Exams of Advanced Education

A detailed overview of acute coronary syndromes (acs), including stable angina pectoris, nstemi, stemi, and prinzmetal's angina. It covers the pathophysiology, clinical presentation, diagnostic workup, and management of these conditions. The document also includes a comprehensive discussion of electrocardiogram (ecg) interpretation, focusing on the identification of st segment elevation myocardial infarction (stemi) in various leads. It further outlines the standard treatment protocol for stemi, emphasizing the importance of timely reperfusion therapy and the use of various medications.

Typology: Exams

2024/2025

Available from 04/10/2025

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Cardiovascular - Acute Coronary Syndromes
PDB CEN Exam
Stable Angina Pectoris
CP that occurs w/ physical exertion, short duration
**relieved by rest or NTG
- negative troponin
NSTEMI
Plaque rupture, absent ST elevation
- positive troponin
STEMI
ST elevation d/t obstruction of vessels w/ thrombosis
- positive troponin
Prinzmetal's Angina
AKA variant angina - ischemia d/t coronary vasospasms (usually stimulants)
- cyclical pain at rest
- vasospasm is precipitated by stress
ST elevation resolves and pain relief when vasospasm resolves*** BB may exacerbate
vasospasm d/t unopposed alpha stimulation
S/S of Acute coronary syndromes
Chest Tightness
Jaw/neck/left arm/epigastric pain
pf3
pf4
pf5
pf8

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Cardiovascular - Acute Coronary Syndromes

PDB CEN Exam

Stable Angina Pectoris CP that occurs w/ physical exertion, short duration **relieved by rest or NTG

  • negative troponin

NSTEMI Plaque rupture, absent ST elevation

  • positive troponin

STEMI ST elevation d/t obstruction of vessels w/ thrombosis

  • positive troponin

Prinzmetal's Angina AKA variant angina - ischemia d/t coronary vasospasms (usually stimulants)

  • cyclical pain at rest
  • vasospasm is precipitated by stress ST elevation resolves and pain relief when vasospasm resolves*** BB may exacerbate vasospasm d/t unopposed alpha stimulation

S/S of Acute coronary syndromes Chest Tightness Jaw/neck/left arm/epigastric pain

scapular discomfort N/V S/sx of schock dysrhythmias diaphoresis dizziness **Women - increased fatigue, scapular, RUQ pain **DM more likely to have silent MI

Labs A/w ACS Troponin - elevation in 3-12 hours, peaks 10- CK-MB (myoglobin) - rises earlier but not specific

Signifant history for those in ACS emergency Use of Phosphodiesterase inhibitors (sildenafil/viagra) w/in last 24 hrs Cocaine - leaves unopposed alpha stimulation if given beta blockers

What is unopposed alpha stimulation acute elevation in blood pressure and/or worsening coronary artery vasoconstriction following the administration of a β-blocker

Limb Leads Leads I, II, III, aVR, aVL, aVF are all derived using 3 electrodes - Right arm, left arm, left leg

Contiguous Leads Leads that view geographically similar areas of the myocardium; useful for localizing areas of ischemia.

**Get posterior ECT when you see ST depression in V1 and V

Precordial Leads V1-V

Inferior contiguous leads II, III, aVF

Anterior Contiguous Leads V1-V4 (Septal V1-V2)

Lateral Contiguous Leads I, aVL (High lateral), V5, V

Reciprocal Leads Leads that oppose contiguous leads

STEMI of the right ventricular vasculature Get right sided EKG

  • proximal RCA
  • S/S - JVD hypotension, shock, STE at V4R
  • TX - caution with preload reducing agents (NTG and Morphine), NS bolus and dobutamine to increase contractility Lateral STEMI I and aVL high lateral, V5, V
  • LAD, Circumflex
  • see reciprocal changes (ST depression in II, II, aVF for high) Posterior STEMI ST segment elevation in V7-V0 or depression in V1,V Standard STEMI Treatment
  • Oxygen at 4L NC if SpO2 <94% or respiratory distress
  • NTG: **** contraindicated if SBP<90 HR <50, phosphodiesterase inhibitor

SL tablet 0.3-0.4 or spray initially 1 tab q 5 min up to 3

IV infusion as needed

Aspirin 162-325mg in chewable form to prevent platelet aggregation

PCI ****catheterization**** expect reperfusion dysrhythmias like accelerated IVR or VT - good sign of reperfusion

→ goal <90 min, fibrinolytic if unavailable within 90-

BB early for hypertensive STEMI patients

ACE/ARBs to decrease infarct size and improve ventricular remodeling

Antiplatelets-aspirin, clopidogrel/Plavix, prasugrel/Effient, ticagrelor/Brilinta-prevention of aggregation of blood clots

Anticoagulants