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2020 ESC Guidelines for NSTEMI PowerPoint Presentation

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Description : Latest guidelines for the management of NSTEMI

Tags : NSTEMI, ACS

Published on : Jan 01, 2021 | Views : 4195 | Downloads : 61

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2020 ESC Guidelines for the management of NSTE-ACS DR DJOUAL DR BENBADA
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4th UDMI= HS-Troponins >99th percentile and : . 2. New ischaemic ECG changes. 3. Development of pathological Q waves on ECG 4. Imaging: loss of viable myocardium or new regional wall motion abnormality 1. Symptoms of myocardial ischaemia 5. Intracoronary thrombus detected on angiography or autopsy Definition
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Different types of MI Type 1 MI Type 2 MI Type 3 MI Type 4 MI Type 5 MI Atherosclerotic plaque rupture, ulceration, fissure, or erosion 1 Imbalance O2 supply / demand: hypotension, hypertension, tachyarrhythmias, bradyarrhythmias, anaemia, hypoxaemia… MI resulting in death when biomarkers are not available MI related to PCI 4 MI related to CABG 5 3 2
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Epidemiology of NSTE-ACS 1995 12.5% 2015 67% 1995 17.2% 2015 6.3% In hospital PCI 6 months mortality Early Angiography <72 h 1995: 9% 2015: 60%
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Clinical Presentation Typical chest discomfort Prolonged at rest De Novo Crescendo Post MI Dyspnoea , Epigastric pain Syncope , Nausea Sweating
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Physical Examination Signs of Aortic Dissection , AS murmur Signs of PE CHF Ischemic MR murmur Hemodynamic stability CHF Other causes of chest pain: PE / AD / Pneumothorax HEART MURMUR MR / AS
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Electrocardiogram Normal 30% cases T changes ST depression Transcient STE LBBB Sgarbossa’s criteria RBBB ST depression I VL V5V6 1st 10mn 12 Leads If inconclusive 18 Leads ECG
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Biomarkers: HS cTn
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All these give positive troponins ?!
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Guidelines
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Why 0/1 h Algorithm ?
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Rapid Rule-in/out Algorithm
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Confounders of cardiac troponin concentration Age Time from chest pain onset Renal Dysfunction Sex
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Page 16 Guidelines
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Guidelines
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Guidelines More than 24 hours monitoring if : Haemodynamic instability Major arrhythmia LVEF <40%, Failed reperfusion Additional critical coronary stenoses of major vessels, Complications related to PCI GRACE risk score >140
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Differential diagnosis
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Specific ECG patterns . Additional Biomarkers Clinical scores: Grace Bleeding risk / Ischemic risk
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Guidelines
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ARC - HBR
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Thank You To be continued…