ACS and PCI Lecture for 3rd Year Medical Students

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ACS and PCI Lecture for 3rd Year Medical Students

• Cardiology Division
• University of Virginia

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Acknowledgments

• Christopher Davis, MD
• David Lin, MD
• Rajan Patel, MD
• David Jones, MD
• Andy Darby, MD
• Rohit Malhotra, MD

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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

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Risk Factors for CAD

• Age
• Race
• Gender
• Hypertension
• Hyperlipidemia

• Diabetes Mellitus
• Smoking
• Family History
• Obesity
• Others

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Physical Exam

• T36.7 HR77 BP130/90 bilaterally
• HEENT 10cm JVD
• CV s4,s1,s2 no murmur/ rub/ heave
• Lungs bilateral rales at bases
• Pulses 2 throughout no bruits

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EKG
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Differential Diagnosis

• Acute Myocardial Infarction
• Aortic Dissection
• Prinzmetals Angina
• Acute Pericarditis
• Early Repolarization
• Acute Takosubos Cardiomyopathy
• Etc

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Coronary Anatomy
RCA dominant in 85 of patients
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Treatment of STEMI

• Aspirin
• Heparin
• Beta Blocker
• Thienopyridine
• Fibrinolytics vs Primary Percutaneous Coronary
  Intervention (pPCI)
• IIb/IIIa Inhibitor

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Vascular Access
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Percutaneous Transluminal Coronary Angioplasty
Wire
Plain Old Balloon Angioplasty
Balloon
Balloon Inflated
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Stent Deployment
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Stent Deployment
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RCA RAO View
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RCA LAO View
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RCA Balloon Angioplasty
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RCA - Post Angioplasty
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Stent Deployment
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Post Stent
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Before and After
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Questions/Comments