(ACS)

ST
ST

1.

2. /
(, ,
, , )
3. ,

4. PCI
4.
5.



:
1. ,
10
2. (46 )
3.


1.

2. (,
Prinzmetal)
3. (

PCI)
4.
/


1. STEMI

2.
, ADP
3. ,
TxA2
4. IIIb/IIa


5. : ,
, ,

Non occlusive thrombus

UA/NSTEMI

occlusive thrombus
STEMI


:
5% .
15 %
30%
40%
10%


/
,



6
,
,

8-10

3-4

6

 STEMI
600000
450000
30 30%,

1/25


75
STEMI

UA

 NSTEMI/UA
1,6
60% UA 40%
: 2/3 NSTEMI, 1/3 STEMI
UA/NSTEMI:6%
11%
STEMI
NSTEMI
10-20% UA .
5-7%

 ACS :

1.
2.
3. ( )



,
stress


24,





: ,

)

, ,

,
,
: , ,
, ,
ACS :
, ,
, ,


:
,
, ,


1/4

1/2

S3, S4,
38

10-15mmHg



85%


30-60%

10%


10

ACS

4%

ACS ( )
3,5%

9,5%

ACS .
ACS

(
)


UA/NSTEMI
30-50% ST,
ST / T
.
>3


:
ST : 0-12
Q: 1-12
ST : 2-5

: -


T
aVR, V1
V2. , V4-V6




1-

2-

QS

( 3 )


Wellens
(
)
R
T ( )
ST ()
ST
(>3 )
()


Wellens



75% PCI,


ST
UA/NSTEMI, STEMI,
STEMI
>0,5


(UA/NSTEMI)
STEMI
40-70% II, III, aVF
STEMI
I, aVL V1-V3


ST
ST
:
1
2
3 UA/NSTEMI


Q




Q:
1- R
2- R
3- R V1-V2 Q



: II, III, avF
: V1-V4
: I, aVL, V5, V6
: V1-V6R
: V7-V9



40%
ST V1

V4R




3,3%-8,5%

V7-V9

V1-V4 R






(8,7% vs 3,5%)
(20% vs 5,6%)
LBBB
RBBB (36% vs
12%)

50%

ST
rSR <1

Sgarbossa
1- ST>1
QRS (V5,V6, I, aVL, III)
2- ST
QRS (V1-V3)
3- ST>5

TnI

4-6

10-24

10-14d

95%

>98%

CPK

4-8

24-36

36-48h

57-88%

93-100%

CK-MB

3-4

15-24

24-36h

93-100%

94-100%

Myoglobin

1-3

6-9

12-24

70%

75-95%

LDH

10-12

48-72

10-14d

88%

63-84%

AST

6-8

24-48

4-6

48-88%

89-97%



Gold Standard


TnI
.






(0,3%)
TnI 24


score
Grace score
Killip

TIMI score STEMI

65-74, >75

<100mmHg
>100
Killip II-IV
<67 kg
S LBBB
>4

TIMI score UA/NSTEMI

>=65
>=3
>50%
ST
>=2 24
7

 Killip
S3 (5-7%)

1/3 S3 (1015%)
1/3
(20-50%)
IV (,
, ) (60-80%)

1.

2.
3.

SaO2<90%
( )





5-10%
162-325mg

 ADP

300-600mg

180mg

60mg

 ADP



<75 ,


1/3

(
P450)

5000 IU bolus

1mg/kg

Fondararinixum

2,5mg

5-10mg (10mg
)

50-75mg ( )


,


,


(<100mmHg)


PVC 80%

10mcg-200mcg/min
1-50mcg/min
>50mcg/min


25mg NTG 250 500ml N/S

100mcg/ml

50mcg/ml

10mcg/min
10mcg 5
200mcg/min
10%


mcg/min

100mcg/ml

50mcg/ml

10

12

20

12

24

30

18

36

40

24

48

: STEMI ( ), LBBB
12

( 0,5-1mg)

(
N/S)
( )

Isuprel
3 amp 250cc N/S DW5%
0,5-10mcg/min
10

60-80mg iv bolus

2-5 mg iv bolus