MI Management: ACS Guideline Review

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ACS Guidelines: Introduction & Overview

Learning Objectives

  • Discuss management of patients with Non-ST-Elevation Acute Coronary Syndromes.
  • Discuss management of patients with ST-Elevation Acute Coronary Syndromes
  • Discuss Hemodynamic management considerations with ACS patients.
  • Discuss Drug management with ACS patients.

Authors

Benjamin Ochoa BS, RCIS, RCS, FACVP - Invasive Cardiovascular Technology Program Director at St. Philip's College

Ben Ochoa is an outstanding cardiovascular technology instructor and educational program director based in San Antonio, Texas at St. Philip's College. Ochoa was recognized in the inaugural class of Fellows of the Alliance of Cardiovascular Professionals for his contributions to the field. He is also deeply involved in mission-focused work in San Antonio as the co-founder of the organizations Upstream Innovations LLC and Work in Industry Now. Connect with Ben on LinkedIn.

This presentation was originally given at a 2018 ACVP Regional Cardio Conference. It has been edited and re-constituted for self-study learning by ACVP staff.

Guideline Overview

This presentation refers to American College of Cardiology, American Heart Association, and Society for Cardiovascular Angiography and Intervention joint guidelines from 2013-2015:

These organizations have not released updated guidelines on these topics since the release of these documents, so this material is still up-to-date.

ACS Overview

Acute Coronary Syndrome refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction due to an abrupt reduction in coronary blood flow. ACS is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery, as depicted:

  1. Depicts a normal artery.
  2. Depicts extracellular lipid in the subintima.
  3. Fibrofatty stage.
  4. Procoagulant expression and weakening of the fibrous cap.

    ACS develops in stages 5-6.
  5. Disruption of the fibrous cap, which is the stimulus for thrombogenesis.
  6. Thrombus resorption may be followed by collagen accumulation and smooth muscle cell growth.

ACS is an umbrella term for a spectrum of clinical presentations ranging from ST-segment elevation myocardial infarction (STEMI) to presentations found in non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The following modules will focus on clinical decision-making algorithms and guidelines for the management of the STEMI and NSTEMI "types" of ACS.