CHEST PAIN

Endorsed by ESC / RSC / AHA / ACC

Claudiu STOICESCU, MD. PhD.

University of Medicine Carol Davila
University Hospital of Bucharest
Department of Interventional Cardiology
 CHEST PAIN
- Still a challenge
 CHEST PAIN
- definition
 CHEST PAIN
- put questions and provide answer
 CHEST PAIN
- put questions and provide answer
 CHEST PAIN
- put questions and provide answer
 CHEST PAIN
- put questions and provide answer
 CHEST PAIN
- differential diagnostic
 CHEST PAIN
- differential diagnostic
 CHEST PAIN
- differential diagnostic
 CHEST PAIN
- differential diagnostic
 CHEST PAIN
- differential diagnostic
 CHEST PAIN
- differential diagnostic
 CHEST PAIN
- Still a challenge
 CHEST PAIN
- Still a challenge
 CHEST PAIN
- Still a challenge
 The ACS spectrum
STEP 1
 The ACS spectrum
STEP 1
 If ST elevation in aVR
…then you have an unexpected outcome
 If De Winter’s T-waves
…then you have an unexpected situation
 Posterior STEMI
… should I stay relax?
 The ACS spectrum
STEP 1
 The ACS spectrum
An overview of the initial triage

Don’t wait hs-TnI to rule-in

 How to make an accurate diagnostic
in suspected ACS!
 Algorithm to fix the ACS
STEP 2
 Invasive coronary angiography
… STEMI
 Invasive coronary angiography
… working diagnosis of STEMI

STEMI all ≤ 12h

 Invasive coronary angiography
… working diagnosis of STEMI

STEMI all ≤ 12h

 Invasive coronary angiography
… STEMI

STEMI all ≤ 12h

 ESC guidelines on ACS:
antithrombotics and pharmacological targets
 ESC guidelines on ACS:
ANTICOAGULANTS
 ESC guidelines on ACS:
Antiplatelet - PRETREATMENT
 ESC guidelines on ACS:
Antiplatelet - first 12 mo
 Guideline for the Evaluation and Diagnosis of Chest Pain
AHA / ACC