- Cardiovascular deaths account for 20 - 25% of total death in govn hospital from 2000-2005
- The high mortality is probably due to delay presentation, delay diagnosis resulting in delay treatment
- Death most frequently occur soon after the onset of symptoms = Pre-hospital phase
- Trials have shown that early reperfusion therapy results in myocardial salvage --> sig reduction in morbidity and mortality
- Hence, need to educate the public regarding the sx and the need to present to hospital early
- Also need to train the ED on the best way to deal with STEMI
- ACS=Unstable angina, STEMI, NSTEMI --> indicates ongoing myocardial ischemia
- Unstable angina/ NSTEMI: Acute Subtotal occlusion of the coronary artery
- STEMI: Acute Total occlusion of the coronary artery (Transmural)
- ACS is most often caused by atherosclerotic occlusion of the coronary arteries (ruptured, fissured, ulcerated on top of thrombosis and coronary vasospasm)
- Rarely, non artherosclerotic occlusion (coronary vasospasm alone, coronary embolism/ vasculitis) causes ACS
- Typical chest pain --> ECG: no ST elevation --> cardiac biomarkers --> normal: Unstable angina
--> ECG: ST elevation --> STEMI
- Criteria for STEMI:
- ECG Changes:
- Evolution of ECG changes (time frame - immediately post occlusion --> weeks --> moths --> years):
- Hyperacute T waves/ Peaked T waves due to localized hyperkalemia
- ST segment elevation at the J point - Concave appearance
- ST segment elevation become more pronounced - change in morphology to convex, rounded upwards
- ST segment elevation may become indistinguishable from T wave
- Q wave develops (indicates irreversible myocardial death) with loss of R wave amplitude as the ST segment elevates
- within x2/52 post MI:
- ST segment returns to the isoelectric baseline
- Deepen Q wave
- T wave inversion
- Reduced R wave amplitude
- Pathophysiology of Myocardial Infarction:
- Acute total occlusion of the coronary artery secondary to atherosclerotic or non atherosclerotic occlusion (rare) leads to myocardial necrosis
- Sequale of event post occlusion
- Evolution of ECG changes in correlation with the cardiac biomarkers
- The ECG leads effected depends on the location of infarct
- Coronary artery anatomy
- Left main stem and Right Coronary Artery arises from the ostia of the aortic valve
- Left main stem divides into the Left Circumflex artery (LCX- supply) and the Left Anterior Descending Artery (LAD - supply the 2/3rd of the anterior interventricular septum and the anterior part of the heart)
- RCA divides into the Posterior Descending Aretry (PDA - supply the psoterior interventricular septum). RCA supplies the SA node, AV node and Inferior border of the LV
- ECG changes:
- Inferior AMI
- Anteroseptal AMI
- Anterolateral AMI
- Right sided Involvement
- Posterior Involvement
- Complications of Myocardial Infarction
- Treatment of AMI:
- Immediate
- Post MI management: Physiorapist, cardiac rehab nurse referral
- Cardiac RF management:
- BP control (how vigorous)
- Blood gluscose control - Dietician referral
- Hyperlipidaemia
- Cardiac Rehabilitation
- Advice to Post MI patients (The Do's and Dont's)
- Anatomy of the Heart
- http://www.wisc-online.com/objects/ViewObject.aspx?ID=AP12504
- ECG: http://lanoswww.epfl.ch/personal/schimmin/uni/ecglex/ekg.htm
- ECG: Eclectrocardiogram
- Records the electrical activity of the heart from the electrodes placed on the skin in specific locations
- Indications:
- Procedure:
- ECHO:
- Indications:
- Procedure:
- Interpretation:
- Anatomy: https://www.healthbase.com/hb/pages/cardiac-surgery.jsp
- Pathophysiology of Atherosclerosis
- Risk fc for artherosclerosis
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