Coronary Artery Disease; A spectrum of syndromes.

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Transcript

1. DISEASE PROGRESS STABLE ANGINA C A D S i m o n M a r k D a l e y ( 2 0 1 9 ) ; a 'spectrum' of syndromes. oronary rtery isease UNSTABLE ANGINA NSTEMI STEMI ACUTE CORONARY SYNDROME (ACS) ST-segment Elevation Myocardial Infarction Non ST-segment Elevation Myocardial Infarction MI (HEART ATTACK) ANGINA THERAPY; ACS THERAPY; Aspirin Ticagrelor (or equivalent) Beta Blocker (or CCB) ACE inhibitor (or ARB) Statin Fondaparinux (pre angio) Coronary angiogram Transthoracic echocardiogram Aspirin Beta Blocker Statin +/- CCB / Nitrate / Ranolazine Coronary angiogram if symptoms continue on 2 anti-anginal agents Exertional ischaemic symptoms troponin -ve ECG likely to be normal, although may show ischaemia - particularly during pain No symptoms at rest Established STABLE ANGINA, now w/ symptoms at rest OR crescendo in nature Ischaemic symptoms Ischaemic symptoms troponin -ve ECG may show ischaemia (less likely) troponin +ve troponin +ve ECG may show ischaemia (more likely) ECG showing ST segment elevation - likely w/ reciprical ischaemia