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Acute Coronary Syndrome Immediate Management
Aka: Acute Coronary Syndrome Immediate Management, Myocardial Infarction Assessment, Ischemic Chest Pain Management, Immediate Myocardial Infarction Management, Immediate MI Management- History: Targeted Brief
- Duration of pain
- Prior Myocardial Infarction
- Cardiac Risk Factors
- Thrombolytic Contraindications
- Exam: Targeted Brief
- Signs of right or left sided Heart Failure
- New murmur or pericardial rub
- Assess tissue perfusion, systemic Blood Pressure
- Asymmetry of peripheral pulses
- Diagnosis
- EKG in Acute MI within 5 minutes
- Consider Echocardiogram in Acute MI if no delay
- Portable Chest XRay within 30 minutes
- Labs
- Electrolytes
- ProTime
- Partial Thromboplastin Time (PTT)
- Serum Cardiac Markers
- Evaluation: Immediate Assessment
- ABC Management
- Mnemonic: IV-O2-Monitor
- Vitals with Oxygen Saturation
- Start Intravenous Access
- Cardiopulmonary monitor
- Consider Differential Diagnosis
- See Chest Pain
- Management: Immediate
- Mnemonic: "MONA" greets all patients
- Morphine Sulfate IV 2-5 mg every 5-30 min prn
- Pain not relieved with 3 Sublingual Nitroglycerins
- Oxygen by Nasal cannula at 4 liters per minute
- Nitroglycerin
- Sublingual Nitroglycerin 0.4 mg
- Nitroglycerin paste (start with 1/2 inch)
- Low threshold to switch to Nitroglycerin Drip
- Non-enteric coated Aspirin 325 mg PO
- Dipyridamole (Persantine) for Aspirin sensitivity
- Morphine Sulfate IV 2-5 mg every 5-30 min prn
- Cardiology Consultation
- Mnemonic: "MONA" greets all patients
- Management: Evaluate 12 lead Electrocardiogram (EKG)
- High Risk Indications: Myocardial Infarction Protocol
- ST Elevation MI (Q-Wave MI)
- New (or presumed new) Left Bundle Branch Block
- No longer considered equivalent to STEMI
- See Myocardial Infarction Protocol for details
- Reperfusion therapy for this is in question (although still in the 2010 ACC guidelines)
- Consider Sgarbossa Criteria (but low Test Sensitivity)
- Jain (2011) Am J Cardiol 107(8): 1111-6
- Moderate Risk Indications: Myocardial Ischemia Protocol
- Non-ST elevation MI (Non-Q-Wave MI)
- ST depression or dynamic T Wave inversion
- High Unstable Angina Risk
- Low Risk: Non-diagnostic Electrocardiogram Protocol
- Absent ST segment or T Wave changes on EKG
- Low Unstable Angina Risk
- High Risk Indications: Myocardial Infarction Protocol
- References
Acute Coronary Syndrome (C0948089) |
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|---|---|
| Definition (NCI) | Signs and symptoms related to acute ischemia of the myocardium secondary to coronary artery disease. The clinical presentation covers a spectrum of heart diseases from unstable angina to myocardial infarction. |
| Definition (NCI) | A disorder characterized by signs and symptoms related to acute ischemia of the myocardium secondary to coronary artery disease. The clinical presentation covers a spectrum of heart diseases from unstable angina to myocardial infarction. |
| Definition (MSH) | An episode of MYOCARDIAL ISCHEMIA that generally lasts longer than a transient anginal episode that ultimately may lead to MYOCARDIAL INFARCTION. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D054058 |
| SnomedCT | 393587009, 394659003 |
| Japanese | 急性冠動脈症候群, ｷｭｳｾｲｶﾝﾄﾞｳﾐｬｸｼｮｳｺｳｸﾞﾝ |
| English | Coronary Syndromes, Acute, Syndromes, Acute Coronary, Acute Coronary Syndromes, Acute Coronary Syndrome, Syndrome, Acute Coronary, Coronary Syndrome, Acute, Acute Coronary Syndrome [Disease/Finding], acute coronary syndromes, syndrome acute coronary, acute coronary syndrome, Acute coronary syndrome, Acute coronary syndrome (disorder), ACS - Acute coronary syndrome |
| Portuguese | Síndrome Coronariana Aguda, Síndrome coronário agudo |
| Spanish | Acute coronary syndrome, Sindrome Coronario Agudo, Síndrome Coronario Agudo, síndrome coronario agudo (trastorno), síndrome coronario agudo, Síndrome coronario agudo |
| Finnish | Akuutti sepelvaltimo-oireyhtymä |
| German | Akutes Koronarsyndrom, akutes Koronarsyndrom |
| Italian | Sindrome coronarica acuta |
| Russian | KORONARNYI SINDROM OSTRYI, КОРОНАРНЫЙ СИНДРОМ ОСТРЫЙ |
| Swedish | Akut koronarsyndrom |
| Czech | Akutní koronární syndrom, akutní koronární syndrom |
| French | Syndrome coronaire aigu, SCA (Syndrome Coronarien Aigu), Syndrome coronarien aigu |
| Polish | Zespół wieńcowy ostry |
| Hungarian | Acut coronaria syndroma |
| Dutch | acuut coronairsyndroom |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Myocardial Ischemia (C0151744) |
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|---|---|
| Definition (CSP) | blood deficiency in the myocardium caused by a constriction or obstruction of its blood vessels; frequently occurs in conjunction with hypoxia, which is reduction in oxygen supply. |
| Definition (NCI) | A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries, to obstruction by a thrombus, or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). |
| Definition (MSH) | A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (CORONARY ARTERY DISEASE), to obstruction by a thrombus (CORONARY THROMBOSIS), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (MYOCARDIAL INFARCTION). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D017202 |
| ICD9 | 410-414.99 |
| ICD10 | I20-I25.9, I20-I25 |
| SnomedCT | 195540001, 2610009, 155322009, 155303000, 233822007, 271430002, 194878003, 194795001, 414545008, 414795007, 41702007, 32598000 |
| English | Disease, Ischemic Heart, Diseases, Ischemic Heart, Heart Disease, Ischemic, Heart Diseases, Ischemic, Ischemic Heart Disease, Ischemic Heart Diseases, Ischemia, Myocardial, Myocardial Ischemia, ISCHEMIA MYOCARDIAL, MYOCARDIAL ISCHAEMIA, Ischemias, Myocardial, Myocardial Ischemias, HEART, ISCHEMIC DISEASE, MYOCARDIAL ISCHEMIA, ISCHEMIC HEART DISEASES, Ischemic heart disease, NOS, Ischaemic heart disease NOS, Ischaemic heart diseases, Ischemic heart disease NOS, Ischemic heart diseases, Ischaemic heart disease, NOS, Myocardial ischaemia, NOS, Myocardial ischemia, NOS, Ischemic heart disease or syndrome, Ischemic Heart Diseases and Syndromes, HEART DIS ISCHEMIC, ISCHEMIC HEART DIS, Cardiac ischaemia, myocardial ischemia (diagnosis), 3-14-15 ISCHEMIC HEART DISEASES, myocardial ischemia, Ischaemic heart disease (disorder), Ischaemic heart disease NOS (disorder), Myocardial ischaemia (disorder), IHD, Ischemia myocardial, Ischemic heart disease NOS (disorder), ISCHEMIC HEART DISEASE, DISEASE, ISCHEMIC HEART, HEART DISEASE, ISCHEMIC, Myocardial Ischemia [Disease/Finding], cardiac ischaemia, Disease;ischaemic heart, ihd, cardiac ischemia, myocardial ischaemia, myocardial ischemia/hypoxia, Ischemic heart diseases (I20-I25), Ischaemia myocardial, ischemia; heart, ischemia; myocardial, myocardium; ischemic, Ischemic heart disease, IHD - Ischaemic heart disease, IHD - Ischemic heart disease, Ischaemic heart disease, Myocardial ischaemia, Myocardial ischemia, Cardiac ischemia, Ischemic heart disease (disorder), Myocardial ischemia (disorder), ischemic heart disease, Disease;ischemic heart, ischaemic heart disease |
| Portuguese | ISQUEMIA MIOCARDICA, Isquemia cardíaca, Isquemia do miocárdio, Cardiopatia isquémica, Cardiopatia Isquêmica, Isquemia miocárdica, Doença Isquêmica do Coração, Isquemia Miocárdica |
| Spanish | ISQUEMIA MIOCARDICA, ECI, Isquemia miocárdica, Enfermedad isquémica cardiaca, Isquemia cardiaca, Cardiopatía isquémica, Myocardial ischaemia, IHD - Ischemic heart disease, IHD - Ischaemic heart disease, Ischemic heart disease, Ischaemic heart disease, Ischaemic heart disease NOS, Myocardial ischemia, Ischemic heart disease NOS, cardiopatía isquémica (concepto no activo), cardiopatía isquémica, SAI (trastorno), cardiopatía isquémica, SAI, enfermedad cardíaca isquémica, SAI, enfermedad cardíaca isquémica, Isquemia de miocardio, cardiopatía isquémica (trastorno), cardiopatía isquémica, enfermedad isquémica del corazón, isquemia miocárdica (trastorno), isquemia miocárdica, Cardiopatía Isquémica, Isquemia Miocárdica, Cardiopatia Isquemica, Isquemia Miocardica |
| Dutch | hartischemie, IHD, ischemische hartziekte, ischemie myocard, ischemische hartaandoening, ischemie; hart, ischemie; myocard, myocard; ischemie, myocardischemie, Hartziekte, ischemische, Ischemie, myocard-, Ischemische hartziekte, Myocardischemie |
| French | Ischémie cardiaque, Maladie cardiaque ischémique, IC, Cardiopathie ischémique, ISCHEMIE DU MYOCARDE, Ischémie myocardique, Ischémie du myocarde |
| German | Myokardischaemie, ischaemische Herzkrankheit, IHD, kardiale Ischaemie, MYOKARDIALE ISCHAEMIE, myokardiale Ischaemie, Herzkrankheit, ischämische, Herzmuskelischämie, Ischämie, Myokard-, Ischämische Herzkrankheit, Myokardischämie |
| Italian | Cardiopatia ischemica, Ischemia cardiaca, Ischemia miocardica |
| Japanese | 心虚血, ｼﾝｷｮｹﾂ, ｷｮｹﾂｾｲｼﾝｼｯｶﾝ, ｼﾝｷﾝｷｮｹﾂ, 心筋虚血, 虚血-心筋, 虚血性心疾患, 心疾患-虚血性, 心臓疾患-虚血性, 虚血性心臓疾患 |
| Swedish | Myokardischemi |
| Finnish | Sydänlihaksen iskemia |
| Russian | ISHEMICHESKAIA BOLEZN' SERDTSA, SERDTSA ISHEMICHESKAIA BOLEZN', ISHEMIIA MIOKARDA, MIOKARDA ISHEMIIA, MIOKARDIAL'NAIA ISHEMIIA, ИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦА, ИШЕМИЯ МИОКАРДА, МИОКАРДА ИШЕМИЯ, МИОКАРДИАЛЬНАЯ ИШЕМИЯ, СЕРДЦА ИШЕМИЧЕСКАЯ БОЛЕЗНЬ |
| Czech | Ischemie myokardu, Myokardiální ischemie, Ischemická choroba srdeční, Srdeční ischemie, ischémie myokardu, myokard - ischémie, ICHS, ischemická choroba srdeční |
| Croatian | MIOKARD, ISHEMIJA |
| Polish | Niedokrwienie mięśnia sercowego |
| Hungarian | Cardialis ischaemia, Szív ischaemia, Szív ischaemiás betegsége, myocardialis ischaemia, Ischaemiás szívbetegség, Szívizom ischaemiája, Szívizom ischaemia, ISzB |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |
Myocardial Infarction (C0027051) |
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|---|---|
| Definition (NCI) | A disorder characterized by gross necrosis of the myocardium; this is due to an interruption of blood supply to the area. |
| Definition (NCI) | Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. |
| Definition (MEDLINEPLUS) |
Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include
These symptoms can sometimes be different in women. What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat â called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die. NIH: National Heart, Lung, and Blood Institute |
| Definition (CSP) | gross necrosis of the myocardium, as a result of interruption of the blood supply to the area. |
| Definition (NCI) | Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis. |
| Definition (MSH) | NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D009203 |
| ICD10 | I22, I21 |
| SnomedCT | 233824008, 22298006, 155304006, 266288001, 66514008, 194796000 |
| English | Myocardial Infarct, Infarctions, Myocardial, Myocardial Infarction, Myocardial Infarctions, Infarcts, Myocardial, Myocardial Infarcts, HEART ATTACK, HEART INFARCTION, INFARCT MYOCARDIAL, Infarct, Myocardial, Infarction, Myocardial, MYOCARDIAL INFARCT, MYOCARDIAL INFARCTION, Cardiac infarction, NOS, Heart attack, NOS, Infarction of heart, NOS, Myocardial infarction, NOS, MI, ATTACK CORONARY, ATTACK HEART (NOS), Myocardial infarction syndrome, Myocardial infarction (MI), mi, Attack heart (NOS), Infarct myocardial, Heart Attack, INFARCTION (MI), MYOCARDIAL, MYOCARDIAL INFARCTION, (MI), MI, MYOCARDIAL INFARCTION, cardiac infarction, Myocardial Infarction [Disease/Finding], AMI, attacking heart, heart attacks, attack hearts, infarctions myocardial, infarcts myocardial, myocardial infarctions, Infarction;heart, myocardial infarcts, Infarction;myocardial, attacks coronary, attacks hearts, coronary attack, disorder infarction myocardial, mied, myocardial necrosis, syndrome myocardial infarction, mies, Myocardial infarct, Myocardial infarction, Heart attack, MI - Myocardial infarction, Cardiac infarction, Infarction of heart, Myocardial infarction (disorder), cardiac; infarction, infarction; myocardial, Attack - heart, Heart Attacks, Infarctions (Myocardial), Myocardial infarction NOS, Attack coronary, myocardial infarction, heart attack, heart infarction |
| German | MYOKARDINFARKT, Koronarattacke, Herzanfall, MI, Herzanfall (NNB), HERZANFALL, Herzinfarkt, Myokardinfarkt |
| Dutch | hartaanval, hartinfarct, hartaanval (NAO), MI, cardiaal; infarct, infarct; myocard, myocardinfarct, Hartinfarct, Infarct, myocard-, Myocardinfarct |
| French | Crise coronaire, IM, Crise cardiaque SAI, Crise cardiaque, CRISE CARDIAQUE, INFARCTUS DU MYOCARDE, IDM (Infarctus Du Myocarde), Infarctus du myocarde, Infarctus myocardique |
| Italian | MI, Attacco cardiaco, Attacco coronarico, Attacco cardiaco (NAS), Infarto del miocardio, Infarto miocardico |
| Portuguese | Ataque coronário, Ataque do coração, Ataque cardíaco NE, EM, ATAQUE CARDIACO, ENFARTO DO MIOCARDIO, Enfarte do miocárdio, Infarto do Miocárdio |
| Spanish | IM, Crisis coronaria, Ataque al corazón, Ataque al corazón (NEOM), Infarto miocárdico, Heart attack, Attack - heart, Myocardial infarct, Myocardial infarction, ATAQUE CARDIACO, INFARTO DE MIOCARDIO, Infarto al Miocardio, ataque al corazón, infarto cardíaco, infarto de corazón, infarto de miocardio (trastorno), infarto de miocardio, Infarto de miocardio, Infarto del Miocardio |
| Japanese | 心臓発作（ＮＯＳ）, 冠発作, 心臓発作, ｶﾝﾎｯｻ, ｼﾝｿﾞｳﾎｯｻNOS, ｼﾝｿﾞｳﾎｯｻ, ｼﾝｷﾝｺｳｿｸ, 冠状動脈梗塞, 心筋梗塞, 冠動脈梗塞, 心筋梗塞症 |
| Swedish | Hjärtinfarkt |
| Czech | infarkt myokardu, Srdeční záchvat, Srdeční záchvat (NOS), IM, Koronární záchvat, Infarkt myokardu |
| Finnish | Sydäninfarkti |
| Russian | INFARKT MIOKARDA, ИНФАРКТ МИОКАРДА |
| Croatian | SRČANI INFARKT |
| Polish | Świeży zawał serca, Zawał serca świeży, Zawał mięśnia sercowego, Zawał serca |
| Hungarian | Coronaria roham, Szívroham (k.m.n.), Szívroham, Infarctus myocardii, Szívizom infarctus, MI |
| Sources |
Derived from the NIH UMLS (Unified Medical Language System) |