ACS and PCI Lecture for 3rd Year Medical Students

Cardiology Division

University of Virginia

HPI

• 53 y/o WM with HTN, HL, and 30 pyh of tobacco abuse who presents with 20 minutes of substernal chest pain

• On EMS arrival, he gets an ECG and during transport has transient complete heart block

Risk Factors for CAD

• Age

• Race

• Gender

• Hypertension

• Hyperlipidemia

• Diabetes Mellitus

• Smoking

• Family History

• Obesity

• Others

Physical Exam

• T=36.7 HR=77 BP=130/90 bilaterally

• HEENT: 10cm JVD

• CV: s4,s1,s2 no murmur/ rub/ heave

• Lungs: bilateral rales at bases

• Pulses: 2+ throughout; no bruits

EKG

Differential Diagnosis

• Acute Myocardial Infarction

• Aortic Dissection

• Prinzmetal’s Angina

• Acute Pericarditis

• Early Repolarization

• Acute Takosubo’s Cardiomyopathy

• Etc…

Coronary Anatomy

RCA dominant in 85% of patients

Treatment of STEMI

• Aspirin• Heparin • Beta Blocker• Thienopyridine

• Fibrinolytics vs Primary Percutaneous Coronary Intervention (pPCI)– IIb/IIIa Inhibitor

Vascular Access

Wire

Balloon

Balloon Inflated

Percutaneous

Transluminal

Coronary

Angioplasty

Plain

Old

Balloon

Angioplasty

Stent Deployment

Stent Deployment

RCA – LAO View

RCA – Balloon Angioplasty

Post Stent

Before and After

Questions/Comments