11. Grade of ischaemia in
EGG depends on
⢠collateral supply
circulation
⢠âdoubleâ
⢠preconditioning
⢠normal ECG does not rule out ACS
⢠negative T waves indicate open vessel
11
12. Occlusion in the LEFT MAIN STEM:
deep ST-depressions and negative T waves in inferolateral
and antero-septal leads
This patient
developed
cardiogenic shock
shortly after
debut of his chest
pain
LM
normal RCA
The patient died
despite initial success
with PPCI
12
13. Culprit in the proximal LAD
(before the take-off of a Diagonal branch) - no protection
ST elevations in I, aVL and V2-V5
Intermediate
Diagonal
LAD
13
14. Occlusion in the proximal RCA:
ST-elevaton in in II, III, aVF + V1 & V4R
RCAa 100%
RCA POST-PTCA
14
16. Abnormal Troponin
possible causes
⢠chronic or acute renal dysfunction
⢠severe congestive heart failure - acute and
chronic
⢠hypertensive crisis
⢠tachy- or bradyarrhythmias
⢠pulmonary embolism, PAH
⢠myocarditis
⢠acute neurological disease, stroke, SAH
16
17. ACS in the
elderly
⢠clinical presentation might
be different (dyspnea)
⢠more extensive and severe
CAD,
⢠more comorbidities, level of
frailty very individual
⢠worse prognosis
⢠differenttherapies
with usual
beneďŹt/risk ratio
⢠higher rate of secondary
effects and complications
Š Gary Larson 2002
17
21. Revascularisation
⢠medical therapy if no critical coronary
lesions if no options for revascularisation
⢠PCI with stenting of the cuprit lesion
⢠individualised decision in multivessel disease
⢠staged PCI or all at once
⢠PCI at ďŹrst and then CABG
⢠CABG
21