Wednesday, March 25, 2009


Ischemic Heart Disease can be divided into 2 categories:
1) Acute IHD / ACS - Unstable angina, NSTEMI, STEMI
2) Chronic IHD - Stable angina, Printzmetal angina


1) Unstable Angina - No ST elevation


- more persistent and severe course
- characterized by at least 1 of these:
a) at rest / minimal exertion, lasts more than 20 minutes (if not interrupted by GTN)
b) described as frank pain & new onset (within 1 month)
c) more severe, prolong or frequent than the previous episode

2) NSTEMI (Subendocardial infarction) -No ST elevation
3) STEMI (Transmural infarction) - Have ST elevation /Q wave

How the chest pain is dexcribed for 2 & 3? - Use LORDSANFARO [but info here might not be fulfilling all these]

L- Substernal
O- Abrupt onset
R- To left arm, neck, jaw, or other chest areas.
D- More prolong (more than 20-30 minutes)
S- ?
A- ?
N- Burning in nature [might be confused with GERD]
F- ?
A- ?
R- Not relieved by rest and GTN.
O- ?

** ACS - is used to describe a spectrum of IHD that includes Unstable Angina, NSTEMI, STEMI.

So, how to diagnose?
1) Do ECG - Any ST elevation? - If yes: STEMI, If no: Unstable angina and NSTEMI

How to differentiate Unstable angine & NSTEMI?
1) Do cardiac enzymes? If -ve: Unstable Angina

** LDH: "Last Diagnostic Hint" - which means the last enzyme.

Refer to: Pathophysio LWW [most] & internet.

that's all till now.

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