bo- card cath lab: acs
DESCRIPTION
TRANSCRIPT
ACS and PCI Lecture for 3rd Year Medical Students
Cardiology Division
University of Virginia
HPI
• 53 y/o WM with HTN, HL, and 30 pyh of tobacco abuse who presents with 20 minutes of substernal chest pain
• On EMS arrival, he gets an ECG and during transport has transient complete heart block
Risk Factors for CAD
• Age
• Race
• Gender
• Hypertension
• Hyperlipidemia
• Diabetes Mellitus
• Smoking
• Family History
• Obesity
• Others
Physical Exam
• T=36.7 HR=77 BP=130/90 bilaterally
• HEENT: 10cm JVD
• CV: s4,s1,s2 no murmur/ rub/ heave
• Lungs: bilateral rales at bases
• Pulses: 2+ throughout; no bruits
EKG
Differential Diagnosis
• Acute Myocardial Infarction
• Aortic Dissection
• Prinzmetal’s Angina
• Acute Pericarditis
• Early Repolarization
• Acute Takosubo’s Cardiomyopathy
• Etc…
Coronary Anatomy
RCA dominant in 85% of patients
Treatment of STEMI
• Aspirin• Heparin • Beta Blocker• Thienopyridine
• Fibrinolytics vs Primary Percutaneous Coronary Intervention (pPCI)– IIb/IIIa Inhibitor
Vascular Access
Wire
Balloon
Balloon Inflated
Percutaneous
Transluminal
Coronary
Angioplasty
Plain
Old
Balloon
Angioplasty
Stent Deployment
Stent Deployment
RCA – LAO View
RCA – Balloon Angioplasty
Post Stent
Before and After
Questions/Comments