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ESC
Superficial Erosion
Presentation Working Dx
ECG
No ST Elevation NSTEMI
ST Elevation
50
Multiples of the URL
20 10 5 2 1 0 1
Upper reference limit
Cardiac troponin after classical AMI CK-MB after AMI Cardiac troponin after microinfarction
Disadvantages
Low sens. early (< 6h) Repeat at 8-12 h if neg. Limited ability to detect late minor reinfarction
Recommendation Useful as single test to efficiently Dx NSTEMI Clinicians should familiarize themselves with Dx cutoffs in local lab
ST Elevation
Uns Angina
Risk Stratification
Purposes Triage / Transfer for Tertiary Care Resource Allocation Selection of Rx Strategy
Prognosis
Continuous Process Presentation: History, ACS features, Biomarkers, PEx In Hospital: Events, Response to Rx Discharge: LV Function, Arrhythmias, Ischemia
UFH ENOX
40.9 28.8
50 40 30 20 10 0
4.7 3.5
8.3 8.6
0/1
6/7
ST Elevation
Uns Angina
Goal = 10 min
Definite ACS
As Per Other Dx
Medical Rx
Symptoms Suggestive of ACS Possible ACS No ST elev. < 12h Lytic eligible Lytic
(D-N < 30 m)
Medical Rx
(ACEI)
Non dx ECG Neg. card. markers Observe f/u studies Neg Neg Outpt f/u Stress Pos Pos
LDL < 100 mg/dL BP: target 135/85 (JNC VI) Diabetics: Hb A1c < 7.0% (ADA) Smoking cessation ACEI (especially if DM, HF, EF < 40%,HTN)
AHA/ACC Scientific Statement: Prevention of MI in Pts with Athero. CVD Circ 104: 1577, 2001