Sierra Acai Company
Sierra Acai Company
Open 7 Days a Week
MonaVie Independent Distributor
Distributor Training
Shop Online
Enroll Now
Buy Wholesale and maintain an Active status for 2 months and we will refund your $39 Distributor Fee
Friends
Buy Wholesale and maintain an Active status for 2 months and we will refund your $39 Distributor Fee
16-September-2008 16:15:15 - coronary syndrome Acute coronary syndrome Classification and external resources eMedicine emerg/31 MeSH D054058 An acute coronary syndrome ACS is a set of signs and symptoms syndrome related to the heart. ACS is compatible with a diagnosis of acute myocardial ischemia,1 but it is not pathognomonic. The subtypes of acute coronary syndrome include unstable angina UA, not associated with heart muscle damage, and two forms of myocardial infarction heart attack, in which heart muscle is damaged. These types are named according to the appearance of the electrocardiogram ECG/EKG as non-ST segment elevation myocardial infarction NSTEMI and ST segment elevation myocardial infarction STEMI.2 There can be some variation as to which forms of MI are classified under acute coronary syndrome.3 ACS should be distinguished from stable angina, which develops during exertion and resolves at rest. In contrast with stable angina, unstable angina occurs suddenly, often at rest or with minimal exertion, or at lesser degrees of exertion than the individual's previous angina crescendo angina. New onset angina is also considered unstable angina, since it suggests a new problem in a coronary artery. Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use.4 Contents 1 Signs and symptoms 2 Diagnosis 2.1 Electrocardiogram 2.2 Imaging and blood tests 2.3 Prediction scores 3 Prognosis 3.1 TIMI score 3.2 Biomarkers for diagnosis 3.3 Biomarkers for Risk Stratification 4 Treatment 4.1 STEMI 4.2 NSTEMI and NSTE-ACS 5 Prevention 6 References Signs and symptoms The cardinal sign of decreased blood flow to the heart is chest pain experienced as tightness around the chest and radiating to the left arm and the left angle of the jaw. This may be associated with diaphoresis sweating, nausea and vomiting, as well as shortness of breath. In many cases, the sensation is atypical, with pain experienced in different ways or even being completely absent which is more likely in female patients and those with diabetes. Some may report palpitations, anxiety or a sense of impending doom and a feeling of being acutely ill. Diagnosis Classification of acute coronary syndromes. Classification of acute coronary syndromes.5 Electrocardiogram In the setting of acute chest pain, the electrocardiogram is the investigation that most reliably distinguishes between various causes.6 If this indicates acute heart damage elevation in the ST segment, new left bundle branch block, treatment for a heart attack in the form of angioplasty or thrombolysis is indicated immediately see below. In the absence of such changes, it is not possible to immediately distinguish between unstable angina and NSTEMI. Imaging and blood tests As it is only one of the many potential causes of chest pain, the patient usually has a number of tests in the emergency department, such as a chest X-ray, blood tests including myocardial markers such as troponin I or T, and a D-dimer if a pulmonary embolism is suspected, and telemetry monitoring of the heart rhythm. Prediction scores The ACI-TIPI score can be used to aid diagnosis; using 7 variables from the admission record, this score predicts crudely which patients are likely to have myocardial ischemia.7 Prognosis TIMI score The TIMI risk score can identify high risk patients8 and has been independently validated.910 Biomarkers for diagnosis The aim of diagnostic markers is to identify patients with ACS even when there is no evidence of myocyte necrosis. Ischemia-Modified Albumin IMA - In cases of Ischemia - Albumin undergoes a conformational change and loses its ability to bind transitional metals copper or cobalt. IMA can be used to assess the proportion of modified albumin in ischemia. Its use is limited to ruling out ischemia rather than a diagnostic test for the occurrence of ischemia. Myeloperoxidase MPO - The levels of circulating MPO, a leukocyte enzyme, elevate early after ACS and can be used as an early marker for the condition. Glycogen Phosphorylase Isoenzyme BB-GPBB is an early marker of cardiac ischemia and is one of three isoenzyme of Glycogen Phosphorylase. Troponin is a late cardiac marker of ACS Biomarkers for Risk Stratification The aim of prognostic markers is to reflect different components of pathophysiology of ACS. For example: Natriuretic peptide - Both B-type natriuretic peptide BNP and N-terminal Pro BNP can be applied to predict the risk of death and heart failure following ACS. Monocyte chemo attractive protein MCP-1 - has been shown in a number of studies to identify patients with a higher risk of adverse outcomes after ACS. Treatment STEMI Main article: Myocardial infarction If the ECG confirms changes suggestive of myocardial infarction ST elevations in specific leads, a new left bundle branch block or a true posterior MI pattern, thrombolytics may be administered or primary coronary angioplasty may be performed. In the former, medication is injected that stimulates fibrinolysis, destroying blood clots obstructing the coronary arteries. In the latter, a flexible catheter is passed via the femoral or radial arteries and advanced to the heart to identify blockages in the coronaries. When occlusions are found, they can be intervened upon mechanically with angioplasty and perhaps stent deployment if a lesion, termed the culprit lesion, is thought to be causing myocardial damage. NSTEMI and NSTE-ACS If the ECG does not show typical changes, the term non-ST segment elevation ACS is applied. The patient may still have suffered a non-ST elevation MI NSTEMI. The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, heparin usually a low-molecular weight heparin such as enoxaparin and clopidogrel, with intravenous glyceryl trinitrate and opioids if the pain persists. A blood test is generally performed for cardiac troponins twelve hours after onset of the pain. If this is positive, coronary angiography is typically performed on an urgent basis, as this is highly predictive of a heart attack in the near-future. If the troponin is negative, a treadmill exercise test or a thallium scintigram may be requested. Prevention Main article: Coronary heart disease Acute coronary syndrome often reflects a degree of damage to the coronaries by atherosclerosis. Primary prevention of atherosclerosis is controlling the risk factors: healthy eating, exercise, treatment for hypertension and diabetes, avoiding smoking and controlling cholesterol levels; in patients with significant risk factors, aspirin has been shown to reduce the risk of cardiovascular events. Secondary prevention is discussed in myocardial infarction. After a ban on smoking in all enclosed public places was introduced in Scotland in March 2006, there was a 17 percent reduction in hospital admissions for acute coronary syndrome. 67% of the decrease occurred in non-smokers.11 References January 2008 ^ Acute Coronary Syndrome. ^ Grech ED, Ramsdale DR June 2003. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ 326 7401: 1259-61. doi:10.1136/bmj.326.7401.1259. PMID 12791748. PMC:1126130. ^ Dorlands Medical Dictionary:acute coronary syndrome. ^ Achar SA, Kundu S, Norcross WA 2005. Diagnosis of acute coronary syndrome. Am Fam Physician 72 1: 119-26. PMID 16035692. ^ Alpert JS, Thygesen K, Antman E, Bassand JP. 2000. Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 36 3: 959-69. doi:10.1016/S0735-10970000804-4. PMID 10987628. ^ Chun AA, McGee SR 2004. Bedside diagnosis of coronary artery disease: a systematic review. Am. J. Med. 117 5: 334-43. doi:10.1016/j.amjmed.2004.03.021. PMID 15336583. ^ Selker HP, Griffith JL, D'Agostino RB 1991. A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use. A time-insensitive predictive instrument TIPI for acute cardiac ischemia: a multicenter study. Medical care 29 7: 610-27. PMID 2072767. ^ Antman EM, Cohen M, Bernink PJ, et al 2000. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 284 7: 835-42. PMID 10938172. ^ Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE 2006. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 13 1: 13-8. doi:10.1197/j.aem.2005.06.031. PMID 16365321. ^ Chase M, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE 2006. Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population. Annals of emergency medicine 48 3: 252-9. doi:10.1016/j.annemergmed.2006.01.032. PMID 16934646. ^ Pell JP, Haw S, Cobbe S et al 2008. Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome. New England Journal of Medicine 359: 482. doi:10.1056/NEJMsa0706740. v d e Cardiovascular disease: heart disease - Circulatory system pathology I00-I52, 390-429 Ischaemic/ Acute coronary CHD: CAD - Coronary thrombosis - Coronary vasospasm - Coronary artery aneurysm Angina pectoris Prinzmetal's angina - Myocardial infarction heart attack Myocardial rupture - Dressler's syndrome Layers Pericardium Pericarditis Acute, Constrictive - Pericardial effusion - Cardiac tamponade - Hemopericardium Myocardium Myocarditis Cardiomyopathy: Dilated Alcoholic - Hypertrophic - Restrictive Loeffler endocarditis, Cardiac amyloidosis Arrhythmogenic right ventricular dysplasia Endocardium/ valves Endocarditis Subacute bacterial endocarditis, Libman-Sacks endocarditis, Nonbacterial thrombotic endocarditis mitral regurgitation, prolapse, stenosis - aortic stenosis, insufficiency - tricuspid stenosis, insufficiency - pulmonary stenosis, insufficiency Conduction/ arrhythmia Heart block AV 1°, 2°, 3° - Bundle branch Left, Right - Bifascicular/Trifascicular - Sinoatrial - Sick sinus syndrome - Adams-Stokes syndrome Pre-excitation syndrome Wolff-Parkinson-White - Lown-Ganong-Levine Tachycardia Paroxysmal - Supraventricular AV nodal reentrant, Accelerated idioventricular rhythm, Sinus - Ventricular Torsades de pointes, Catecholaminergic polymorphic Premature contraction Atrial - Ventricular Flutter/fibrillation Atrial flutter - Ventricular flutter - Atrial fibrillation Familial - Ventricular fibrillation Pacemaker Wandering pacemaker - Ectopic pacemaker - Parasystole Long QT syndrome Romano-Ward syndrome - Andersen-Tawil syndrome - Jervell and Lange-Nielsen syndrome Cardiac arrest Sudden cardiac death - Asystole Other Cardiomegaly - Ventricular hypertrophy Left, Right/Cor pulmonale Heart failure Cardiac asthma - Rheumatic fever See also congenital, neoplasia Retrieved from http://en..org/wiki/Acute_coronary_syndrome Categories: Medical emergencies | Ischemic heart diseasesHidden category: Articles needing additional references from January 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Italiano Polski اردو This page was last modified on 12 August 2008, at 09:10
39 Reasons to Drink Acai Juice Every Day
What is MonaVie - Watch the 8-minute video
Discovering MonaVie Video
The Power of You Video
Effects of MonaVie Active on Antioxidant Capacity in Humans
Log into your Wholesale MonaVie Account
So many of us do not eat a balanced diet, get enough sleep, have too much stress, or are impacted with toxins and pollutants. Drinking 2 ounces of MonaVie twice a day will help your body detoxify as well as build your immune system. Its the smartest thing you can do for yourself, so start today. Buying MonaVie through our company guarantees you support 7 days a week and, if you would like to share MonaVie with your family and friends we will guide you from start to finish.
1. Click on Enroll Now (30 - 55% off retail price)
2. Pay $39 for your Wholesale ID number.
3. NO minimum order required.
4. MonaVie is delivered to your door in 3 to 5 days.