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Pinching chest pain RARA KHAIRANIA MAYFA 1908260065 - Coggle Diagram
Pinching chest pain
RARA KHAIRANIA MAYFA 1908260065
ACS definition
Acute coronary syndrome (ACS) = Heart Attack
“refers to spectrum of presentations that is consistent to be caused by myocardial ischemia”
ACS Classification
By ECG differentiation
NSTE-ACS
Unstable
Angina
NSTEMI
STE-ACS
STEMI
ACS etiology
Coronary Heart Disease (CHD) is a heart disease that is mainly caused by narrowing of the arteries coronary artery disease due to atherosclerotic processes or spasm or a combination of both, CHD continues to be the leading cause of death.
ACS risk factors
CHD is determined by several factors, namely
(1) factors that cannot be changed, including age, gender, smoking, hypertension, hypercholesterolemia and exercise behavior,
(2) factors that can be changed, namely lifestyle changes.
How to diagnose ACS
ACS is A CLINICAL DIAGNOSIS not an ECG diagnosis.
Recognize the symptom correctly
Typical chest pain
Quality
Squeezing, heaviness, pressure, weight, very strong pain, burning, tightness
Location
Centre of the chest, left chest with radiation to shoulder, neck, jaw, inner arm, epigastrium (can occur without chest pain)
Duration
Unstable angina 10-20 min.
Myocardial infarction last longer
Setting
Triggered by exercise, sexual activity, exposure to cold weather, emotional stress (anger, fright, frustration), or a large meal.
Reliever or exaggerator
No effect of position or respiration to quantity or quality of chest pain. Lessened by nitrat
Look For Risk Factors
Evidence of ACS:
Role of ECG in ACS
SCORE risk factors
The charts should be used in the light of the clinician's knowledge and judgment, especially with regard to local conditions.
As with all risk estimation systems, risk will be over estimated in countries with a falling CVD mortality rate, and under estimated if it is rising.
At any given age, the risk appears lower for women than men. However, inspection of the charts shows that their risk is merely deferred by 10 years, with a 60 year old woman resembling a 50 year old man in terms of risk.
Risk may be higher than indicated in the chart in:
Sedentary or obese subjects, especially those with central obesity
Those with a strong family history of premature CVD
Socially deprived individuals and those from some ethnic minorities
Individuals with diabetes- the SCORE charts should only be used in those with type 1 diabetes without target-organ damage; Other diabetic subjects are already at high to very high risk.
Those with low HDL cholesterol* or increased triglyceride, fibrinogen, apoB, Lp(a) levels and perhaps increased high-sensitivity CRP.
Asymptomatic subjects with evidence of pre-clinical atherosclerosis, for example plaque on ultrasonography.
Those with moderate to severe chronic kidney disease (GFR <60 mL/min/1.73 m2)
Pretest probability testing
Pretest probability for CAD can be estimated from the patient's age, sex, and chest pain symptoms. Pretest probability may play a role in approach to patients before requesting a CT CA.
ACS complications
The most common complications of coronary heart disease include: sudden death, sudden or chronic heart failure, arrhythmic disorders (impaired heartbeat), stroke (brain attack) and heart valve damage.
CVD prevention classification
Cardiac prevention for individual
There are 9 important CV Risk Factors
In each individual, assess the risk of CVD's. Use SCORE or Framingham Risk Score.
Prevention strategy includes: diet, maintain ideal body weight, physical activity, quit smoking, and management of DDH (Diabetes, Dyslipidemia, Hypertension)
Dyslipidemia management usually use NCEP-ATP III or ACC-AHA Style
Levels of prevention consist of primordial, primary, secondary, tertiary
Statins, Aspirin, ACE inhibitors are the drugs used for CV prevention