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Feedback Cardiology

Acute Coronary Syndrome – CF, dx, ddx

Clinical features

Diagnosis

ECG changes

  • ST depression and T-wave inversion – highly suggestive of NSTE-ACS
  • STEMI – complete occlusion of a coronary vessel
  • Results in persistent ST-elevation
  • Or LBBB

REMEMBER

  • ST Elevation – infarction (irreversible damage)
  • ST Depression – ischemia (reversible with prompt tx)

Biochemical markers

  • Cardiac troponin complex
    • Troponin levels  rise from 2-24hrs after pain, peak at 24-48hrs, and return to baseline after 5-14 days
    • Troponins I, T, C
      • T – attaches the complex to tropomyosin
      • C – binds Ca during excitation-contraction
      • I – inhibits the myosin binding site on actin
    • Normal serum troponin – <5ng/L
    • ↑ Serum troponin – increased mortality in ACS patients
  • CK-MB – raised after muscle trauma
    • Levels drop back to normal after 36-72hrs
    • Replaced by troponin testing, but can be used to determine re-infarction
Chest X-Ray

Differential diagnosis

Cardiac

Pulmonary

Oesophageal

  • Reflux or spasm
  • Tumour
  • Oesophagitis

Risk stratification – Grace Score

  • Risk stratification is important because it guides the use of pharmacological and interventional treatment

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