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Cardiology Teaching Package

A Beginners Guide to Normal Heart Function, Sinus Rhythm & Common Cardiac Arrhythmias

Risk Stratification

Acute Coronary Syndrome Risk Stratification

1. ST Elevation Myocardial Infarction (STEMI)

Initial presentation with ST segment elevation and, if untreated, subsequent pathological Q waves. These patients have normally occluded a large coronary artery. These are the patients we need to thrombolyse in order to reduce the threat of widespread myocardial cell death and ventricular damage.

A patient presenting with ST segment elevation on ECG accompanied by cardiac chest pain is a candidate for immediate thrombolysis. (we do not await biomarker results.)

PLEASE NOTE. Thrombolysis would not be given if there were any conta-indications to treatment, such as: recent surgery; history of bleeding problems; history of strokes, hypertension amongst others.

2. Non-ST Elevation Myocardial Infarction (NSTEMI)

These patients present with ST depression, T wave inversion or minor ST/T wave changes with associated elevated biomarkers, particularly Troponin. These patients have usually sustained a much smaller infarct with a small amount of myocardial necrosis, not enough to cause an abnormal CK rise but enough to cause Troponin elevation.

This is a HIGH-RISK group if Troponin is greater than 0.1Ng/lt. This group do not benefit from Thrombolysis but are often treated with an IV anti-platelet treatment called Tirofiban, followed by angiography.

3. Non-ST Elevation Myocardial Infarction (NSTEMI)

With a Troponin result of 0.03-0.09 Ng/lt are considered an INTERMEDIATE RISK group. This group would go onto an oral anti-platelet drug known as Clopidogrel. (pronounce it as you wish.)

4. Ustable Angina

This group has cardiac chest pain at rest or with mild exertion, but with normal biomarkers. Although this group is a LOW-RISK group, they will still be considered for further investigation and intervention if symptoms persist.

Summary of ACS treatments

All patients must have a history of cardiac chest pain.

PLEASE NOTE. Under certain circumstances, such as diabetes where pain sensation may be absent, a patient might be thrombolysed in the absence of chest pain.

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