acute coronary syndromes in west hertfordshire masood khan
TRANSCRIPT
Acute Coronary Syndromes in West Hertfordshire
Masood Khan
Cardiology Connect Meeting 16 June 2010
Chronology of Atherosclerotic Vascular Disease
Cardiology Connect Meeting 16 June 2010
AntithromboticTherapy
Stable Angina
UnstableAngina
Non–Q-wave MI
ThrombolysisPrimary PCI
Q-wave MI
Minutes-hours
Days-weeks
STEMINSTEMIAtherothrombosisNew term
Old term
PlaqueRupture
Current terminology in ACS
Normal cardiac enzymes Elevated cardiac enzymes
Unstable Angina
Cardiology Connect Meeting 16 June 2010
Outcomes: Admission to 6 Months
12
3
17
13
3
20 20
1.5
8
0
10
20
30
Death Stroke Urgent readmission forcardiac event
Pa
tie
nts
(%
)
STEMI (2075)NSTEMI (1856)UA (2883)
Global Registry of Acute Coronary Events
Cardiology Connect Meeting 16 June 2010
Treatment of ACS
STEMI
Immediate PCI
NSTEMI
Early PCI
UA
Non-invasive or PCI
Risk assessment
Lifestyle changes and secondary prevention
Chest pain
Early suspicion and diagnosis
Cardiology Connect Meeting 16 June 2010
Cardiology Connect Meeting 16 June 2010
ACS pain Pain in chest, arms,
back or jaw >15 min
Associated with:Nausea/vomitingBreathlessnessSweating
Do not assess symptoms differently
ethnic groups, or
gender
Do not use response to GTN to make diagnosis
Cardiology Connect Meeting 16 June 2010
ACS hospital referral
Currently in pain,
or Pain free, but pain in
last 12 hours and ECG abnormal or unavailable
Same day:
Chest pain within 12 hours, butNow pain free, andECG normal
or
Chest pain 12-72 hours
Cardiology Connect Meeting 16 June 2010
ACS – start management immediately!
Chest pain
Pain relief GTN Opiate
Aspirin 300mg
Pulse oximetery O2 if SpO2 < 94%
12 lead ECG STE or LBBB? ACS not excluded if ECG normal
Cardiology Connect Meeting 16 June 2010
Secondary prevention
Secondary prevention
Aspirin 75 mg od Dyspepsia: + low dose PPI Healed Ulcer: + high dose PPI
Β-blocker
Clopidogrel 7mg od for 1 yr
ACE inhib orA2 antag
Statin dose and drug controversial
Aldosterone antag.If present in heart failure
Cardiology Connect Meeting 16 June 2010
ACS in W Herts 2 consultant cardiology ward rounds each
week day, 1 each Sat & Sun All cardiology patients & referrals
Appropriate management decisions Timely discharge
Cardiac catheter lab available 5 days/week Dedicated slots for in patients
Cardiology Connect Meeting 16 June 2010
ACS in W Herts
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1 2 3 4 5 6 7 WGH
Trust
Da
ys
Adx to ref. Ref. to lab
Data from NW London IHT
603 inpatient referrals to WGH cathlab in 2009
0
NICE target <96 hrs
Cardiology Connect Meeting 16 June 2010
West Herts. Heart Attack Centre
Nationaltarget
Cardiology Connect Meeting 16 June 2010
ACS in W Herts Currently auditing appropriateness of
discharge medication
100% referral to cardiac rehabilitation
All patients undergoing PCI offered follow up in cardiology clinic follow up time should be shorter
Thank you