Acute Coronary Syndromes (ACS)

University:
The University Of Western Ontario
Course:
ANAT 2200B | Systemic Anatomy of the Human Body
Academic year:

2022
Views:

105

Pages:

3
Author:

Kyuwon J.

Acute Coronary Syndromes (ACS) ● Spectrum ○ STEMI ■ Complete occlusions ● ST elevation ● transmural infract ○ NSTEMI ■ Partial occlusions ● No ST elevations ● Troponin increase ○ Unstable angina ■ Ischemia ■ No troponin rise could be seen ■ No ST elevations ● Pathophysiology ○ Plaque rupture => platelets aggregation =>thrombus ○ Imbalance in supply vs demand ○ Cocain ■ Induces vasospasm on a-adrenergic stimulations ECG territories ● Lateral wall ○ Leading I, aVL, V5, V6 ○ Left Circumflex + diagonal branches on LAD ○ ST elevation ○ Lateral STEMI ● Inferior Wall ○ Lead II,III,aVF ○ Rit coronary Artery in most patients ○ ST elevation could be seen => Inferior STEMI ○ Risk in large myocardial territory = high mortality ● Anterior Wall ○ V1-V4 ○ Left anterior Descending (LAD) ○ ST elevation =>Anterior STEMI ○ Large myocardial territory ECG Leads Territory (Heart Wall) Main Coronary Artery Involved V1 – V4 Anterior wall Left Anterior Descending (LAD) I, aVL, V5 – V6 Lateral wall Left Circumflex (LCx) ± diagonal branches II, III, aVF Inferior wall Right Coronary Artery (RCA) ± LCx V1 – V3 (ST depression, tall R waves) Posterior wall (reciprocal changes) Usually RCA, sometimes LCx ● Anterior STEMI ○ LAD occlusion ○ Highest mortality risks ● Inferiority STEMI ○ RCA occlusions ○ Verify right ventricular involvement ○ V4R ● Posterior MI ○ If ST depression in V1-V3 with tail R wave ● Lateral MI ○ ○ ○ ○ Isolated I aVL V5-V6 changes

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