Doença arterial coronariana III (síndrome coronariana aguda) | CARDIOLOGIA

Summary

This video focuses on the diagnosis and treatment of Acute Coronary Syndrome (ACS), specifically addressing unstable angina and non-ST elevation myocardial infarction (NSTEMI). It outlines the key diagnostic steps, including ECG analysis and cardiac markers, to differentiate between unstable angina and NSTEMI. The treatment approach involves several pharmacological interventions such as nitrates, beta-blockers, antiplatelets (ticagrelor), and antithrombotics (heparin). The video also discusses the use of GP 2b/3a inhibitors and ACE inhibitors in the management of ACS, aimed at improving patient survival and preventing further complications. The video concludes with a preview of the next installment, which will cover the more severe condition of STEMI.

Takeaways

• 😀 Acute Coronary Syndrome (ACS) is a sudden progression of chronic coronary artery disease, requiring rapid attention and intervention.
• 😀 ACS can be classified into two main categories based on ECG changes: one with ST-segment elevation (STEMI) and one without (NSTEMI), with this video focusing on NSTEMI.
• 😀 NSTEMI involves plaque rupture, platelet aggregation, and the formation of a thrombus, leading to partial arterial occlusion and potential myocardial infarction (MI) or unstable angina.
• 😀 The key difference between NSTEMI and unstable angina is that in NSTEMI, myocardial tissue undergoes necrosis due to ischemia, while in unstable angina, tissue death does not occur.
• 😀 Medications like statins and antiplatelet drugs (e.g., aspirin) are essential in managing chronic coronary disease and preventing progression to ACS.
• 😀 A significant part of ACS treatment includes stabilizing the thrombus and preventing further clot formation, which can lead to more severe complications like STEMI.
• 😀 Diagnosing ACS requires attention to clinical symptoms (e.g., chest pain), ECG changes, and biomarkers like troponin and CK-MB to differentiate between unstable angina and NSTEMI.
• 😀 In the case of NSTEMI, the most common ECG findings include T-wave inversions and ST-segment depression, though some patients may have normal ECG results.
• 😀 Troponin levels are highly specific for myocardial injury and are used to confirm the diagnosis of NSTEMI. Troponin levels can remain elevated for up to 14 days, unlike CK-MB, which peaks and drops more quickly.
• 😀 Treatment for NSTEMI includes medications such as nitrates, beta-blockers, antiplatelet agents (e.g., ticagrelor), and anticoagulants like heparin to prevent further clot formation and reduce the risk of reinfarction.

Q & A

What is Acute Coronary Syndrome (ACS)?

Acute Coronary Syndrome (ACS) is a group of conditions that occur due to the sudden rupture of atherosclerotic plaques in the coronary arteries, leading to partial or complete blockage of blood flow to the heart muscle. It includes unstable angina and non-ST elevation myocardial infarction (NSTEMI).

What is the primary difference between unstable angina and NSTEMI?

Unstable angina involves partial blockage of the coronary artery, causing chest pain without irreversible heart muscle damage. NSTEMI, on the other hand, also involves partial blockage but results in damage to the heart muscle due to ischemia.

How do atherosclerotic plaques contribute to ACS?

Atherosclerotic plaques consist of a lipid-rich core surrounded by a fibrous cap. When these plaques rupture, the lipid core is exposed to the bloodstream, triggering platelet aggregation and thrombus formation, which can block blood flow and lead to ACS.

What are the primary diagnostic tools for ACS?

The main diagnostic tools for ACS include a clinical history assessment, an electrocardiogram (ECG), and biomarkers such as troponin, CK-MB, and myoglobin to identify myocardial damage.

What role does the ECG play in diagnosing ACS?

An ECG is used to assess the heart's electrical activity. In ACS, it can show characteristic changes such as ST-segment elevation (in STEMI) or lack of ST elevation (in NSTEMI), which helps differentiate between types of myocardial infarction.

Why are biomarkers important in diagnosing ACS?

Biomarkers like troponin, CK-MB, and myoglobin are critical in distinguishing between unstable angina and NSTEMI. Elevated levels of these biomarkers indicate myocardial necrosis, confirming the diagnosis of NSTEMI.

What are the key medications used in the treatment of ACS?

The key medications include antiplatelet agents (e.g., aspirin, ticagrelor), antithrombotic drugs (e.g., heparin, enoxaparin), beta-blockers to reduce myocardial oxygen demand, nitrates for vasodilation, and ACE inhibitors to prevent heart remodeling.

How do beta-blockers help in managing ACS?

Beta-blockers reduce myocardial oxygen demand by lowering heart rate and blood pressure, which helps prevent further damage to the heart muscle during ACS.

What is the role of ACE inhibitors in ACS treatment?

ACE inhibitors are started within 24 hours of an ACS event to help prevent remodeling of the myocardium, which could otherwise lead to heart failure. They reduce the workload of the heart and improve long-term outcomes.

What is the TIMI score, and how is it used in ACS?

The TIMI (Thrombolysis in Myocardial Infarction) score is a risk stratification tool that helps assess the likelihood of adverse outcomes in ACS patients. It is used to guide decisions regarding further interventions such as angiography or revascularization.