1.Ranil de Silva Consultant Cardiologist Senior Lecturer in Clinical Cardiology

2. Goals of the initial clinical evaluation Is this an ACS? What is the prognosis? 3. Clinical diagnosis of ACS 4. Acute Coronary Syndromes ST depression T wave inversionST elevation ESC NSTE-ACS Guidelines 2007 or normal ECG 5. Cardiac Enzyme Changes in ACS ESC NSTE-ACS Guidelines 2007 6. Cardiac Magnetic Resonance Imaging 7. Prognostication in ACS Clinical 12 lead ECG Biomarkers 8. Clinical prognostication in ACS 9. Troponin and Prognosis Lindahl et al NEJM 2000 10. Risk scores for prognosis in ACS 11. Risk of death after ACS (GRACE) In-hospital 6 months post-discharge High (score >140) >3% Intermediate (score 109-140) 1-3% Low (score 108) 118) >8% Intermediate (score 89-118) 3-8% Low (score 88)