Lesson topic №24. ОКС (Acute Coronary Syndrome )

A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that

began after eating a large meal. Pain is now present but is minimal. Aspirin is the single drug that will have the greatest potential

impact on subsequent morbidity. In the setting of ongoing symptoms and ECG changes, nitrates titrated to 10% reduction in blood

pressure and symptoms, beta-blockers, and heparin are all indicated. If the patient continues to have persistent signs and/or symptoms of ischemia, addition of a glycoprotein IIb/IIIa inhibitor should be considered.

A 62-year-old woman with a history of chronic stable angina and a "valve problem" presents with new chest pain. She is symptomatic on arrival, complaining of shortness of breath and precordial chest tightness. Her initial vital signs are blood pressure 140/90 mm Hg and heart rate is 98. Her ECG is as shown. She is given nitroglycerin sublingually, and her pressure decreases to 80/palpation. Right ventricular ischemia should be considered in this patient.

Although rare, pediatric and adult ACS may result from the following (see Myocardial Infarction in Childhood):

ACS may occur with Marfan syndrome; Kawasaki disease; Takayasu arteritis; or cystic medial necrosis with aortic root dilatation, aneurysm formation, and dissection into the coronary artery.

Anomalous origin of the left coronary artery from the pulmonary artery may occur as unexplained sudden death in a neonate.

Coronary artery ostial stenosis may occur after repair of a transposition of the great arteries in the neonatal period.

An aberrant left main coronary artery with its origin at the right sinus of Valsalva may cause ACS, especially with exertion.

Traumatic myocardial infarction can occur in patients at any age.

Accelerated atherosclerosis is known to occur in cardiac transplant recipients on immunosuppressive therapy.

ACS may occur with progeria.

Thank you for your attention.