Professional Documents
Culture Documents
EPIDEMIOLOGY/PREVALENCE/DEFINITION
m TREATMENT/MANAGEMENT UPDATE
m Coronary Artery Disease ² leading
cause of morbidity & mortality in
industrialized nations.
m Although decrease in cardiovascular
mortality still major cause of
morbidity & burden of disease.
m HIGH RISK POPULATION FOR CAD/ACS:
INDIAN
m Increasing due to
Lifestyle/socioeconomic changes,
urbanization
m ECG
m BIOCHEMICAL MARKERS
m First point of entry into ACS algorithm
m Troponins
m CKMB
m Myoglobin
m Other markers
m Troponin T vs I ²
m both equivalent in diagnostic and
prognostic abilities ( except in renal failure ²
Trop T less sensitive)
CKMB
Used in conjunction with troponins
Useful in diagnosing re-infarction
HEART FATTY ACID BINDING PROTEIN (HF ABP)
m Identifies AMI <4hrs after onset
m Protein involved in myocardial lipid
synthesis, but also expressed outside heart
m Therefore may be sensitive but not specific
for injury
m Possible role in multi-marker strategy
m Cardiac MRI
m Multidetector CT for coronary
calcification
m Coronary CT angiography
m Undergoing clinical evaluation
m Cardiac biomarkers measured in all
patients with suspicion of ACS
m Troponin preferred marker
m If troponin negative within 6 hours of onset,
repeat 8-12hours later
m Remeasuring of positive biomarkers to
determine infarct size/necrosis
m Patients presenting within 6 hours of
symptom onset ² myoglobin in
conjunction with troponin measured
(Class 2b B)
m 2hr delta CKMB/Delta troponin
considered in <6hr presentation
m BNP level ² for global risk assessment
m Class 3 ² AST/LDH/CK without CKMB
m 2007 ACS/AHA GUIDELINES:
m Risk stratification models useful in decision making with regard
to treatment options ( Class 2a B)
m TIMI vs GRACE vs PURSUIT
m Oral B Blockers in first 24hrs still Class 1 ² but not used in signs of
heart failure, cardiogenic shock and reactive airway
disease.(LOE B)
m SMOKING CESSATION
m BP CONTROL
m LIPID MANAGEMENT
m EXERCISE
m DIABETES MANAGEMENT
m Despite good reperfusion strategies approx.
1/3 of patients worldwide miss out.
m Attributed to ² delayed presentation,
atypical presentation, complicated disease
presentation, older age