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| ==Heading 2==
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| | | | align="center" style="background:#f0f0f0;"|'''Stoke Type''' |
| ===Heading 3=== | | | align="center" style="background:#f0f0f0;"|'''Target BP (mm Hg)''' |
| | | | align="center" style="background:#f0f0f0;"|'''Notes''' |
| ==Heading another==
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| | | | Acute Ischemic Stroke|||| |
| == Next heading ==
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| | | | IV tPA eligble||<185/110|| |
| | | |- |
| ''For risk stratification see [[ACS - Risk Stratification]]'' | | | During/after tPA||<180/105||Monitor BP every 15 min for 2 hr, then every 30 minfor 6 hr, then hourly until 24 hr. |
| ==Background==
| | |- |
| [[File:MI types.png|thumbnail|Myocardial Infarction types]]
| | | No tPA||<220/120|| |
| *Abbreviation: ACS
| | |- |
| *Refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow.
| | | Mechanical thrombectomy||BP <=180/105||Maintain during and for 24 h after procedure |
| | | |- |
| ===Clinical Categories===
| | | Aneurysmal subarachnoid hemorrhage|||| |
| #[[ST-Elevation Myocardial Infarction (STEMI)]] (30%)
| | |- |
| #[[Non ST-Elevation Myocardial Infarction (NSTEMI)]] (25%)
| | | Unsecured||SBP <140-160||Controversy regarding exact number; others recommend <100 MAP |
| #[[Unstable Angina]] (38%)
| | |- |
| #*The new title, “Non-ST-Elevation Acute Coronary Syndromes,” emphasizes the continuum between UA and NSTEMI<ref>AHA ACA - NSTEMI ACS Guidelines 2014 [http://circ.ahajournals.org/content/130/25/e344 View Online]</ref>
| | | Secured||Unclear||May depend on ppremorbid BP and presence of vasospasm |
| #*NSTEMI myocardium is damaged enough to increase biomarkers, UA is not. | | |- |
| | | | Intraparenchymal hemorrhage|||| |
| ===MI Types by Causation<ref>Third Universal Definition of Myocardial Infarction http://circ.ahajournals.org/content/126/16/2020.full.pdf</ref>===
| | |- |
| *Type 1 - Spontaneous Myocardial Infarction
| | | Initial SPB 150-220||SBP <140|| |
| **Atherosclerotic plaque rupture or intraluminal thrombus in one or more of the coronary arteries
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| *Type 2 - Myocardial Infarction Secondary to an Ischaemic Imbalance
| | | Initial SPB >220||SBP 140-160|| |
| **Condition other than CAD contributes to an imbalance between myocardial oxygen supply and/or demand
| | |} |
| *Type 3 - Cardiac Death Due to Myocardial Infarction
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| **Suffer cardiac death with symptoms suggestive of myocardial ischaemia without elevated biomarkers
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| *Type 4 - Myocardial Infarction Associated With Revascularization Procedure
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| **4a: Related to PCI
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| **4b: Related to Stent Thrombosis
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| *Type 5 - Myocardial Infarction Related to CABG Procedure
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| ===Prognosis===
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| *[[ACS - Stress Testing]]
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| ==Clinical Features==
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| {{Clinical features ACS}}
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| ==Differential Diagnosis==
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| {{Chest Pain DDX}}
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| {{Elevated troponin DDX}}
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| ==Evaluation==
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| ===Workup===
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| *[[ECG (Diagnosis)]]
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| **[[ECG]] is normal in 8% of all confirmed MI's
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| **In [[LBBB]] see [[Sgarbossa's Criteria]]
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| *[[Cardiac Enzymes]]
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| ===Evaluation=== | |
| *HEART Pathway: https://www.mdcalc.com/heart-pathway-early-discharge-acute-chest-pain
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| *[[ACS - Risk Stratification]]
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| {{ACS anatomical correlation}}
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| ==Management==
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| ''Intensity of treatment should be based on ACS likelihood'' | |
| | |
| *[[ST-Elevation Myocardial Infarction (STEMI)]]
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| *[[Non ST-Elevation Myocardial Infarction (NSTEMI)]]
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| *[[Unstable Angina]]
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| ==Disposition==
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| *Admit
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| **Ischemic ECG changes
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| **Pacemakers
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| **LBBB
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| **Positive troponins
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| **Abnormal vital signs
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| *ACC/AHA rec need for provocative testing withing 72 hrs, consider admitting
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| *For low risk (HEART) pts, may be better off discharge home with follow up<ref> Weinstock MB, Weingart S, Orth F, VanFossen D, Kaide C, Anderson J, Newman DH. Risk for Clinically Relevant Adverse Cardiac Events in Patients With Chest Pain at Hospital Admission. JAMA Intern Med. 2015 Jul;175(7):1207-12. </ref>
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| **Risk of MACE after neg ED work up 1/2422 vs Risk of preventable adverse event in hospital is 1/164
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| ==External Links== | |
| *[https://www.mdcalc.com/heart-pathway-early-discharge-acute-chest-pain MDCalc - HEART Pathway]
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| *[http://www.mdcalc.com/framingham-coronary-heart-disease-risk-score/ MDCalc - Framingham Coronary Heart Disease Risk Score]
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| *[http://www.mdcalc.com/sgarbossa-criteria-for-mi-in-left-bundle-branch-block/ MDCalc - Sgarbossa’s Criteria for MI in Left Bundle Branch Block]
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| *[http://www.mdcalc.com/timi-risk-score-for-uanstemi/ MDCalc - TIMI Risk Score for UA/NSTEMI]
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| *[http://www.heart.org/HEARTORG/ Heart Association]
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| ==See Also==
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| *[[ACS - Risk Stratification]]
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| *[[ACS - Anatomical Correlation]]
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| *[[ACS - Stress Testing]]
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| *[[ST-segment elevation myocardial infarction (STEMI)]]
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| *[[Non ST-Elevation Myocardial Infarction (NSTEMI)]]
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| *[[Unstable angina]]
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| *[[STEMI equivalents]]
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| *[[Myocardial infarction complications]]
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| ==References==
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| <references/>
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| [[Category:Cardiology]]
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