1 DIAGNOSTICS OF Acute Coronary Syndromes At the end of this self study the participant will: • Verbalize meanings of specific ECG changes: – ST Elevation – ST Depression • Describe common tests used for patients with suspected Acute Coronary Syndromes
DIAGNOSTICS OF Acute Coronary Syndromes. At the end of this self study the participant will: Verbalize meanings of specific ECG changes: ST Elevation ST Depression Describe common tests used for patients with suspected Acute Coronary Syndromes. Abbreviations:. ACS = Acute Coronary Syndrome - PowerPoint PPT Presentation
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DIAGNOSTICS OF Acute Coronary Syndromes
At the end of this self study the participant will:• Verbalize meanings of specific ECG changes:
– ST Elevation– ST Depression
• Describe common tests used for patients with suspected Acute Coronary Syndromes
• Door to Data (ECG) Goal < 10 min.• Door to Decision Goal < 20 min.• Door to Drug Goal < 30 min.• Door to Dilatation Goal < 90 min.
• Door can be time of patient arrival, or time the patient tells nursing staff of possible ACS signs and symptoms
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Door to Data: 10 minutes
• INITIAL DIAGNOSIS– 12-LEAD ECG
• ST Elevation– ST elevation MI (STEMI) – All High
Risk• No ST elevation
– Acute Coronary Syndrome OR Non ST elevation MI (Non STEMI)
» High, Intermediate or Low Risk
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Lead Placement to obtain a 12-lead.
V lead (chest lead) placement must be exact.
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Normal 12 Lead EKG ConfigurationsIn order to more easily recognize abnormalities in the 12 lead ECG one must first be able to recognize the normal 12 lead ECG
Look for:
•Flat baseline
•Little to no artifact (waveforms are clear)
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12-lead changes seen in ACS
1.4 MMNon-ST elevation ACS
0.6 MMST-elevation MI
~ 2.0 MM patients admittedto CCU or telemetry annually
ST Elevation ST depression T wave inversion
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Ischemia
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Injury
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ECG Progression
in AMI
From Garcia, et.al. (2001). 12 Lead ECG. The Art of interpretation, pg. 408. Used by permission.
ST-segment elevation may occur within the first few hours of infarction.
ST-segment elevation is indicative of injury that is leading to infarction.
When ST-segment elevation is seen, time is limited and the healthcare provider must act quickly to initiate a reperfusion strategy in order to salvage the most myocardium.
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Non-diagnostic ECGs
• According to the National Registry of Myocardial Infarction, only 39% of Acute MI patients have STEMI on admit
• Subsequent STEMI occurs within 12 hrs of symptoms• Acute MI patients who present & maintain normal or
nonspecific ECGs have lower mortality rates; Increased mortality risk associated with development of STEMI
Fesmire, FM, et al. Ann Emerg Med. 1998: 31: 3-11.Littrell, KA, et al. JACC. 2001: 37 Suppl A p. 1282-101. French, WJ, et al. NRMI 4 Special Report, June 2001Welch, RD, et al. JAMA, 2001: 286: 1977-1984.
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Door to decision: 20 minutes
• Based on ECG and patient presentation• Does not require lab data nor advanced assessments
such as angiography (cardiac catheterization)• If decision is AMI, treatment planned
– Door to Drug 30 minutes– Door to Dilatation (PCI) 90 minutes
• If decision is not AMI, further evaluation is required
Sheaths are used with all PCI’s– Assess for bleeding at site, and under the site;
outline ecchymotic areas– Note any perfusion changes around site– Palpate abdomen for firmness or distention– Be alert to changes in oxygenation assessment and
hemodynamic status• If bleeding is seen at site, place immediate manual