Acute coronary syndrome Keerapa phusunti MD Chokchai hospital

Acute coronary syndrome Keerapa phusunti, MD. Chokchai hospital

Pathophysiology

Acute STEMI Acute coronary syndrome NSTEMI Non-STE-ACS Unstable angina

Acute coronary syndrome Acute STEMI Non-STE-ACS Dual antiplatelet +antithrombotic Fibrinolysis or primary PCI Moderate to high risk CAG or revascularization Low risk Risk stratification

Acute STEMI (< 12 hrs) First medical contact to PCI time <120 min Primary PCI C/I fibrinolysis or cardiogenic shock >120 min fibrinolysis successfull Failed

Fibrinolytic drug 1. 5 million units over 30 -60 minute IV

Dose of agent co thrombotic therapy ASA : starting dose 150 -300 mg orally Plavix : loading dose 300 mg orally ; patient≥ 75 loading 75 mg

Primary PCI Dose of antioplatelet co therapy for primary PCI Loading dose 150 -300 mg Loading dose 600 mg

Normal EKG

Anterior wall MI Cause cardiogenic shock

Anterior wall MI

Inferior wall MI

Inferior wall MI

V 3 R, V 4 R

V 3 R, V 4 R Right ventricular infarction

Right ventricular infarction • Right ventricular infarction complicates up to 40% of inferior STEMIs • can develop severe hypotension in response to nitrates or other preload-reducing agents. • Hypotension in right ventricular infarction is treated with fluid loading, and nitrates are contraindicated

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