ABC: časopis urgentne medicine (Jan 2016)

Acute coronary syndrome without ST elevation (NSTEMI)

  • Niković Vuk,
  • Savović Slavko,
  • Radunović Milena,
  • Bulajić Ranka,
  • Vujović Mirko,
  • Milenković Dušan

Journal volume & issue
Vol. 16, no. 1
pp. 58 – 65

Abstract

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INTRODUCTION: Term acute coronary syndrome refers to aggregate of clinical syndrome which are caused by abrupt(acute) circulatory disorder in coronary arteries with subsuquent ischaemia of corresponding parts of myocard. It covers spectrum from nonstable angina pectoris and myocardial infarction without ST elevation(NSTEMI) to myocardial infarction with ST elevation (STEMI) CASE REPORT: We have shown the case of 58y/o man with acute coronary syndrome without ST elevation (NSTEMI). During his usually everyday stroll, patient felt intense chest pain which radiated to arms, accompanied with shortness of breath and diaphoresis. Twenty minutes after the onset of pain, he checked into the ambulance. ECG has been recorded, which has shown the following: sinus rhythm, heart rate 79 bpm, ST depression in V4 and V4 and T-wave inversion in V1-V2. Blood pressure was 140/80 mmHg. Peripheral venous line was inserted along with nasal catheter for oxygen administration with flow rate of 4 liters per minute. Nitroglycerine spray with single dose of 0.4 mg was administered and andol pill (300 mg) was given per os. Patient was rushed to ER. In ER blood sample was taken and it has detected elevated cardiac troponin levels; heart ultrasonography was performed and patient was admitted to Center for cardiology. Coronarography was performed, occlusion of coronary arteries was detected(two- vessel disease), which was treated with myocardial revascularisation. CONCLUSION: As it resulted from this case study, diagnosis of acute coronary syndrome is based on thoroughly taken medical history, focused physical examination, evaluation of risk factors and adequate diagnostic tests. The key diagnostic procedure in patient with suspected acute coronary syndrome was recording of rest-ECG. In all patients with chest pain, ECG must be recorded, not longer than 10 minutes upon arrival to the ambulance . If ECG is normal, recording should be repeated in 6 and 12 hours.

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