Acute Coronary Syndromes in West Hertfordshire

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Acute Coronary Syndromes in West Hertfordshire

• Masood Khan

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Chronology of Atherosclerotic Vascular Disease
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Current terminology in ACS
PlaqueRupture
Stable
Unstable
Q-wave
NonQ-wave MI
Old term
Angina
Angina
MI
STEMI
Unstable Angina
NSTEMI
Atherothrombosis
New term
Days- weeks
Minutes-hours
Antithrombotic
Thrombolysis Primary PCI
Therapy
Normal cardiac enzymes
Elevated cardiac enzymes
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Outcomes Admission to 6 Months
Global Registry of Acute Coronary Events
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Treatment of ACS
Chest pain
Early suspicion and diagnosis
STEMI Immediate PCI
NSTEMI Early PCI
UA Non-invasive or PCI
Risk assessment
Lifestyle changes and secondary prevention
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ACS pain

• Pain in chest, arms, back or jaw gt15 min
• Associated with
• Nausea/vomiting
• Breathlessness
• Sweating

• Do not assess symptoms differently
• ethnic groups, or
• gender
• Do not use response to GTN to make diagnosis

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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, but
• Now pain free, and
• ECG normal
• or
• Chest pain 12-72 hours

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ACS start management immediately!

• Pain relief
• GTN
• Opiate

• Pulse oximetery
• O2 if SpO2 lt 94

Chest pain

• 12 lead ECG
• STE or LBBB?
• ACS not excluded if ECG normal

Aspirin 300mg
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Secondary prevention

• Aspirin 75 mg od
• Dyspepsia low dose PPI
• Healed Ulcer high dose PPI

Clopidogrel 7mg od for 1 yr
ACE inhib orA2 antag
Secondary prevention
?-blocker
Aldosterone antag.If present in heart failure

• Statin
• dose and drug controversial

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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

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ACS in W Herts
603 inpatient referrals to WGH cathlab in 2009
NICE target lt96 hrs
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Data from NW London IHT
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West Herts. Heart Attack Centre
National target
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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

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Thank you