Acute Myocardial Ischaemia Terminology, Pathophysiology and Recognition
Summary
The most obvious effect of coronary artery disease (CAD) is the compromise on the oxygenation of the myocardial cells, which leads to an entity known as ischemic heart disease. CAD cause approximately one third of all deaths in persons above 35 years old.
In its acute form, it initially presents as a particularly serious condition known as acute coronary syndrome (ACS) and represents a group of medical conditions with different stages of a continuum that may be indistinguishable at presentation to emergency departments. They share similar pathogenic mechanisms, being the common link the rupture of a vulnerable coronary atherosclerotic plaque and the formation of the intracoronary thrombus.
General Information
Enrolled trainees 3114
Open 24.09.2019
Available for ESICM members
Student effort 1
Last Updated June 3, 2022
Intended Learning Outcomes
After studying this module on Acute Myocardial Ischaemia Terminology, Pathophysiology and Recognition, you should be able to:
- Review the latest definition, causes and pathophysiology of acute coronary syndrome
- Recognise how to confirm a diagnosis of acute coronary syndrome with the use of the contemporary detection strategies
- Demostrate how to manage acute coronary syndrome with the latest strategies
- Recognise the evidence based secondary prevention strategy in acute coronary syndrome.
- Distinguish between myocardial injury and myocardial infarction (MI)
- Distinguish between acute myocardial injury with/without myocardial ischaemia and chronic myocardial injury
- Define and differentiate UA, NSTEMI, and STEMI.
- Distinguish between acute myocardial injury related to either acute coronary athero-thrombosis (MI type 1) or to an imbalance between myocardial oxygen supply/demand secondary to underlying stressor(s) (MI type 2)
- Distinguish between procedural related myocardial injury and procedural related myocardial infarction (MI types 4a or 5)
- Discuss the pathophysiology of acute coronary syndromes describing the role of atherosclerotic plaque, platelets, and the coagulation system.
- Describe the therapy for acute coronary syndromes (aspirin, thrombolytic therapy, etc.) in terms of the underlying pathophysiology
- Explain the complications of acute myocardial infarction
- Define the mechanisms of heart failure and cardogenic shock in coronary artery disease
- Triage, identify and activate immediate management strategies of patients with suspected ACS
- Apply algorithm diagnostic to rule in/out ACS (ECG, biomarkers and imaging techniques) and confirm a diagnosis of AMI
- Distinguish ST-segment elevation MI (STEMI) and non-STEMI by different prognosis and treatment strategy
- Detect ACS and distinguish the types of myocardial infarction that can occur in critically ill patients
- Discuss the role of primary PCI in the management of AMI and appropriate pharmacotherapy
- Establish risk stratification models (clinical, ischemic and bleeding) of STEMI and non-SETMI
Relevant competencies in CoBaTrICE
- 1.1 Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
- 1.4 Triages and prioritises patients appropriately, including timely admission to ICU.
- 2.1 Obtains a history and performs an accurate clinical examination
- 2.2 Undertakes timely and appropriate investigations
- 2.4 Performs electrocardiography (ECG / EKG) and interprets the results
- 2.9 Monitors and responds to trends in physiological variables.
- 2.10 Integrates clinical findings with laboratory investigations to form a differential diagnosis.
- 3.1 Manages the care of the critically ill patient with specific acute medical conditions
- 3.3 Recognises and manages the patient with circulatory failure.
- 4.1 Prescribes drugs and therapies safely.
- 5.1 Administers oxygen using a variety of administration devices
- 11.6 Critically appraises and applies guidelines, protocols and care bundles
- 12.1 Communicates effectively with patients and relatives
- 12.2 Communicates effectively with members of the health care team
- 12.3 Maintains accurate and legible records / documentation
- 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
- 12.7 Collaborates and consults; promotes team-working
- 12.8 Ensures continuity of care through effective hand-over of clinical information
Enrollment Options
You are currently NOT enrolled in this course.
This course is available only for registered ESICM members.
If you are an ESICM member you can enrol yourself by clicking the Enrol Me button.
If there is no Enrol button on the top left of this card please check that you have login and that you are an ESICM Member.
Verify that you are logged in the Academy using your valid ESICM account to enrol yourself in the course.
Disclaimer
All authors of ACE courses sign a document declaring absence or any actual or potential conflicts of interest. In addition, they sign a copyright document confirming the work is their own and that they have obtained the necessary permission for any copyrighted material. The latter document also transfers the intellectual copyright to the ESICM. Both the conflict of interest and copyright forms are filed and stored in compliance with GDPR and are available for inspection upon request.