BLOCK 4: Acute Coronary Syndrome
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Learning Objectives By Lesson
1-General Concepts in Acute Coronary Syndrome (ACS)
  • Describe the objectives of patient care for acute coronary syndrome (ACS)
  • Outline the timeline of events in acute coronary syndrome (ACS) management -- from initial presentation to long-term care
  • Describe the therapeutic strategies for acute coronary syndrome (ACS)
  • List of the main goals of reperfusion in acute coronary syndrome (ACS)
  • Describe the timing of reperfusion for acute coronary syndrome (ACS)
  • Describe the risk stratificaton approach for acute coronary syndrome (ACS)
  • Describe the mechanism of lytic agents
  • Identify blood thinning agents used in acute coronary syndrome (ACS)
2-Reperfusion in ST-Elevation Myocardial Infarction (STEMI)
  • List the main reperfusion approaches in ST-elevation myocardial infarction (STEMI)
  • Describe the time of greated benefit of fibrinolysis during ST-elevation myocardial infarction (STEMI)
  • Identify important contraindications of fibrinolysis during ST-elevation myocardial infarction (STEMI)
  • Describe the overall performance of fibrinolysis versus percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI)
  • Describe when a specific reperfusion strategy (i.e., fiibrinolysis versus percutaneous coronary intervention) in ST-elevation myocardial infarction (STEMI) might be more appropriate
  • Describe the general timeline of events at a non-percutaneous coronary intervention capable hospital for ST-elevation myocardial infarction (STEMI) management
  • Describe the goals of fibrinolysis in percutaneous coronary intervention
  • Describe the therapeutic approach of antithrombotic agents (i.e., antiplatelets and anticoagulants) for supporting reperfusion (both fiibrinolysis and percutaneous coronary intervention) in ST-elevation myocardial infarction (STEMI)
3-Reperfusion in Non-ST-Elevation Myocardial Infarction (NSTEMI)
  • Describe the ischemia-guided strategy of care in non-ST-elevation acute coronary syndrome (NSTE-ACS)
  • Describe the early-invasive strategy of care in non-ST-elevation acute coronary syndrome (NSTE-ACS)
  • Identify which patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) should undergo an early-invasive strategy of care
  • Describe the role of antithrombotic agents in non-ST-elevation acute coronary syndrome (NSTE-ACS)
  • Describe the use of antiplatelet therapy in non-ST-elevation acute coronary syndrome (NSTE-ACS) based on the strategy of care (ischemia-guided versus early-invasive)
  • Describe the use of anticoagulation in non-ST-elevation acute coronary syndrome (NSTE-ACS) based on the strategy of care (ischemia-guided versus early-invasive)
  • Describe the use of antithrombotic agents following coronary angiography
  • Identify the clinical utility of proton-pump inhibitors with antithrombotic agents
4-Adjunctive Cares in Acute Coronary Syndrome (ACS)
  • Review the timeline of events in acute coronary syndrome (ACS)
  • Describe the important tasks clinicians must undertake in preparing a patient for hospital discharge following admission for acute coronary syndrome (ACS)
  • Identify therapies that should be weaned off prior to hospital dismissal following admission for acute coronary syndrome (ACS)
  • List beneficial maintenance medications for acute coronary syndrome (ACS)
  • Describe important comorbidities to consider following acute coronary syndrome (ACS)
  • List medications to avoid following acute coronary syndrome (ACS)
  • List recommended behavioral modificiations following acute coronary syndrome (ACS)
5-Mechanical Complications in Acute Coronary Syndrome (ACS)
  • List the potential mechanical complications from acute coronary syndrome (ACS)
  • Describe the impact of emergency revascularization for acute coronary syndrome (ACS) complicated by cardiogenic shock
  • Identify sensitive ECG markers for acute right ventricular myocardial infarction
  • Describe the pathophysiology and net effects of systolic and diastolic dysfunction in acute right ventricular myocardial infarction
  • Describe the importance of atrial function in the context of acute right ventricular myocardial infarction
  • Describe the basic management strategies for acute right ventricular myocardial infarction
  • Describe the general anatomical findings in left ventricular aneurysm as a complication of acute coronary syndrome (ACS)
  • Describe the pathophysiology behind ischemic mitral regurgitation
  • Describe the basic treatment strategy for ischemic mitral regurgitation
  • Identify the timeframe of when most ischemic rupture complications occur
  • Identify anatomical components of the papillary muscles
  • Describe why the papillary muscles (especially the posteromedial papillary muscle) are at risk of ischemia during acute coronary syndrome (ACS)
  • Describe the hemodynamics effects associated with papillary muscle rupture
  • Describe the pressure-time graph in acute mitral regurgitation
  • Describe the basic treatment strategy for papillary muscle rupture
  • Identify the post-infarct ventricular septal defect location associated with anterior and inferior myocardial infarctions
  • Describe the hemodynamic effects associated with post-infarct ventricular septal defect
  • Describe the basic treatment strategy for post-infarct ventricular septal defect
  • Describe what is meant by infarct expansion
  • Identify features associated with free wall rupture as a complication of acute coronary syndrome (ACS)
6-Electrical & Non-Myocardial Complications in Acute Coronary Syndrome (ACS)
  • Describe electrical complications that can arise in the setting of acute coronary syndrome (ACS)
  • Describe when ventricular arrhythmias in the context of acute coronary syndrome (ACS) might be assocaited with poor outcomes
  • Identify risk factors associated with supraventricular tachyarrhythmias in the context of acute coronary syndrome (ACS)
  • Identify when pacing should be considered for bradyarrhythmias in the context of acute coronary syndrome (ACS)
  • Describe non-myocardial complications that can arise from of acute coronary syndrome (ACS)
  • Describe the basic management for post-myocardial infarction pericarditis
  • Identify the preferred anticoagulant for patients with heparin-induced thrombocytopenia and concomittant acute myocardial infarction who require stenting
  • Describe an antithrombotic management approach for patients with an independent indication for anticoagulation and acute coronary syndrome (ACS)
Contributors: Nandan Anavekar, MBBCh; Mahmoud Ismayl, MD; Khalid Saeed Al-Asad, MD; Adnan Halboni, MD; Adolfo Martinez Salazar, MD; Anthony Kashou, MD
Last updated: January 2023.
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