733
edits
Myocardial Infarction: Difference between revisions
Jump to navigation
Jump to search
→Non-ST-segment elevation Acute Coronary Syndrome
| (10 intermediate revisions by 2 users not shown) | |||
| Line 34: | Line 34: | ||
==Cardiac Markers== | ==Cardiac Markers== | ||
[[File:Cardiac_markers.png|thumb|right|Rise and fall of several cardiac markers based on whether the myocardium was reperfused or not]] | |||
Cardiac markers are essential in order to confirm the diagnosis of MI, indicated by elevated Creatine Kinase isoenzyme MB (CK MB) and/or (high-sensitive) troponins. Troponins are more specific and sensitive than CK MB. The cardiac troponin concentration begins to rise around 4 hours after the onset of myocardial cell damage.<Cite>REFNAME12</Cite> | Cardiac markers are essential in order to confirm the diagnosis of MI, indicated by elevated Creatine Kinase isoenzyme MB (CK MB) and/or (high-sensitive) troponins. Troponins are more specific and sensitive than CK MB. The cardiac troponin concentration begins to rise around 4 hours after the onset of myocardial cell damage.<Cite>REFNAME12</Cite> | ||
| Line 63: | Line 64: | ||
===Non-ST-segment elevation Acute Coronary Syndrome=== | ===Non-ST-segment elevation Acute Coronary Syndrome=== | ||
[[Image:Swe.jpg|thumb|right|400px|link=http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html|The [http://www.outcomes-umassmed.org/grace/acs_risk/acs_risk_content.html GRACE risk score model]]] | |||
Comparable to STEMI, revascularization in NSTE-ACS relieves symptoms, shortens hospital | Comparable to STEMI, revascularization in NSTE-ACS relieves symptoms, shortens hospital | ||
stay, and improves prognosis. However, NSTE-ACS patients represent a heterogenous population, and indication and timing of revascularization depend on many factors, including the baseline risk of the patient. According to current guidelines, depending on early risk stratification a choice has to be made between a routine invasive or a selective invasive (or “conservative strategy”) <Cite>REFNAME27</Cite> | stay, and improves prognosis. However, NSTE-ACS patients represent a heterogenous population, and indication and timing of revascularization depend on many factors, including the baseline risk of the patient. According to current guidelines, depending on early risk stratification a choice has to be made between a routine invasive or a selective invasive (or “conservative strategy”) <Cite>REFNAME27</Cite> | ||
Early risk stratification is helpful to identify patients at high risk who might benefit the most from a more aggressive therapeutic approach in order to prevent further ischemic events. <Cite>REFNAME28</Cite> | Early risk stratification is helpful to identify patients at high risk who might benefit the most from a more aggressive therapeutic approach in order to prevent further ischemic events. <Cite>REFNAME28</Cite> | ||
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="500px" | |||
|- | |||
|colspan="5" align="center"|'''GRACE risk score''' | |||
|- | |||
!Risk Category | |||
!low | |||
!Intermediate | |||
!High | |||
|- | |||
|NSTEMI Probability of Death In-hospital (%) | |||
|<1 | |||
|1-3 | |||
|>3 | |||
|- | |||
|NSTEMI 6 Month Post-discharge Mortality | |||
|<3 | |||
|3-8 | |||
|>8 | |||
|- | |||
|STEMI In-hospital Mortality (%) | |||
|<2 | |||
|2-5 | |||
|>5 | |||
|- | |||
|STEMI 6 Month Post-discharge Mortality | |||
|<4.4 | |||
|4.5-11 | |||
|>11 | |||
|} | |||
Early risk stratification can be performed using one of the validated risk scores, such as the GRACE risk score. GRACE calculates the probability of death while in hospital. The following characteristics are taken into account: | Early risk stratification can be performed using one of the validated risk scores, such as the GRACE risk score. GRACE calculates the probability of death while in hospital. The following characteristics are taken into account: | ||
| Line 89: | Line 120: | ||
====Cardiac rehabilitation==== | ====Cardiac rehabilitation==== | ||
Cardiac rehabilitation reduces mortality, helps the patient to regain confidence and to resocialise, and helps to reduce risk factors for atherosclerosis. Post-ACS patient should be referred for cardiac rehabilitation. | Cardiac rehabilitation reduces mortality, helps the patient to regain confidence and to resocialise, and helps to reduce risk factors for atherosclerosis. Post-ACS patient should be referred for cardiac rehabilitation. | ||
== References == | == References == | ||
<biblio> | <biblio> | ||