The difference between STE-ACS (STEMI) and NSTE-ACS (NSTEMI, UA) is merely the presence of ST elevations on ECG. Hence, patients with NSTEMI typically do not develop pathological Q-waves. – Angine instable: ECG N ou avec changement ST -T, tropo négative, DRS généralement moins sévère et moins longue. NSAIDs (except from aspirin) increases mortality in patients with acute coronary syndromes.ACUTE MYOCARDIAL INFARCTION IN PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION (MANAGEMENT OF)  – European Society for CardiologyClinical electrocardiography and ECG interpretationCardiac electrophysiology: action potential, automaticity and vectorsThe ECG leads: electrodes, limb leads, chest (precordial) leads, 12-Lead ECG (EKG)The Cabrera format of the 12-lead ECG & lead –aVR instead of aVRECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave)How to interpret the ECG / EKG: A systematic approachMechanisms of cardiac arrhythmias: from automaticity to re-entry (reentry)Aberrant ventricular conduction (aberrancy, aberration)Premature ventricular contractions (premature ventricular complex, premature ventricular beats)Premature atrial contraction (premature atrial beat / complex): ECG & clinical implicationsSinus rhythm: physiology, ECG criteria & clinical implicationsSinus bradycardia: definitions, ECG, causes and managementChronotropic incompetence (inability to increase heart rate)Sinoatrial arrest & sinoatrial pause (sinus pause / arrest)Sinoatrial block (SA block): ECG criteria, causes and clinical featuresSinus node dysfunction (SND) and sick sinus syndrome (SSS)Sinus tachycardia & Inappropriate sinus tachycardiaAtrial fibrillation: ECG, classification, causes, risk factors & managementAtrial flutter: classification, causes, ECG diagnosis & managementEctopic atrial rhythm (EAT), atrial tachycardia (AT) & multifocal atrial tachycardia (MAT)Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & managementPre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT), Wolff-Parkinson-White (WPW syndrome)Junctional rhythm (escape rhythm) and junctional tachycardiaVentricular rhythm and accelerated ventricular rhythm (idioventricular rhythm)Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment (management)Longt QT interval, long QT syndrome (LQTS) & torsades de pointesVentricular fibrillation, pulseless electrical activity and sudden cardiac arrestPacemaker mediated tachycardia (PMT): ECG and managementDiagnosis and management of narrow and wide complex tachycardiaIntroduction to Coronary Artery Disease (Ischemic Heart Disease) & Use of ECGClassification of Acute Coronary Syndromes (ACS) & Acute Myocardial Infarction (AMI)Clinical application of ECG in chest pain & acute myocardial infarctionDiagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & SymptomsMyocardial Ischemia & infarction: Reactions, ECG Changes & SymptomsThe left ventricle in myocardial ischemia and infarctionFactors that modify the natural course in acute myocardial infarction (AMI)ECG in myocardial ischemia: ischemic changes in the ST segment & T-waveST segment depression in myocardial ischemia and differential diagnosesST segment elevation in acute myocardial ischemia and differential diagnosesST elevation myocardial infarction (STEMI) without ST elevations on 12-lead ECGT-waves in ischemia: hyperacute, inverted (negative), Wellen's sign & de Winter's signECG signs of myocardial infarction: pathological Q-waves & pathological R-wavesSupraventricular and intraventricular conduction defects in myocardial ischemia and infarctionECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit)Approach to patients with chest pain: differential diagnoses, management & ECGNSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, ManagementSTEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & managementSecond-degree AV block: Mobitz type 1 (Wenckebach) & Mobitz type 2 blockThird-degree AV block (3rd degree AV block, AV block 3, AV block III)Management and treatment of AV block (atrioventricular blocks)Intraventricular conduction delay: bundle branch blocks & fascicular blocksRight bundle branch block (RBBB): ECG, criteria, definitions, causes & treatmentLeft bundle branch block (LBBB): ECG criteria, causes, managementLeft bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteriaFascicular block (hemiblock): left anterior & left posterior fascicular block on ECGNonspecific intraventricular conduction delay (defect)Atrial and ventricular enlargement: hypertrophy and dilatation on ECGECG in left ventricular hypertrophy (LVH): criteria and implicationsRight ventricular hypertrophy (RVH): ECG criteria & clinical characteristicsBiventricular hypertrophy ECG and clinical characteristicsLeft atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECGDigoxin - ECG changes, arrhythmias, conduction defects & treatmentECG changes caused by antiarrhythmic drugs, beta blockers & calcium channel blockersECG changes due to electrolyte imbalance (disorder)ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndromeBrugada syndrome: ECG, clinical features and managementEarly repolarization pattern on ECG (early repolarization syndrome)Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy)Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatmentEletrical alternans: the ECG in pericardial effusion & cardiac tamponadeExercise stress test (treadmill test, exercise ECG): IntroductionExercise stress test (exercise ECG): Indications, Contraindications, PreparationExercise stress test (exercise ECG): protocols, evaluation & terminationExercise stress testing in special patient populationsExercise physiology: from normal response to myocardial ischemia & chest painEvaluation of exercise stress test: ECG, symptoms, blood pressure, heart rate, performanceGeneral principles of management of NSTEMI and unstable anginaDefinitions and classification of acute coronary syndromes (acute myocardial infarction)NSTEMI and unstable angina are caused by partial (incomplete) occlusionsAcute and long-term complications of NSTEMI and unstable anginaNormal ECG in patients with NSTEMI or unstable anginaClinical assessment and initial evaluation of patients with NSTEMI and unstable anginaIntravenous antiplatelet agents: Glycoprotein (GP) IIb/IIa receptor antagonistsFeatures guiding the timing of revascularization for unstable angina or NSTEMIFibrinolysis (thrombolysis) in NSTEMI and unstable anginaGeneral principles of management of NSTEMI and unstable anginaDefinitions and classification of acute coronary syndromes (acute myocardial infarction)NSTEMI and unstable angina are caused by partial (incomplete) occlusionsAcute and long-term complications of NSTEMI and unstable anginaECG criteria for the diagnosis of NSTEMI and unstable anginaNormal ECG in patients with NSTEMI or unstable anginaClinical assessment and initial evaluation of patients with NSTEMI and unstable anginaEvidence-based therapies for NSTEMI & unstable anginaIntravenous antiplatelet agents: Glycoprotein (GP) IIb/IIa receptor antagonistsFeatures guiding the timing of revascularization for unstable angina or NSTEMIPersistent high-risk or dynamic electrocardiographic changes.No features requiring an immediate or early invasive strategy.Recurrent angina or signs of ischaemia despite therapies.Ejection fraction <40%, diabetes, renal insufficiency  (estimated glomerular filtration rate <60 mL/min/1.73 m.), prior coronary artery bypass grafting, or percutaneous If PCI is performed, the patient should receive a stent.Fibrinolysis (thrombolysis) in NSTEMI and unstable angina Yet, the EMS is heavily underutilized in patients with acute myocardial infarction (AMI); according to the NRMI registry, approximately half of patients with AMI use the EMS. Cardiac troponin I or T levels are obtained at presentation and 3 to 6 hours after symptom onset. If a total of 30 mg morphine is insufficient to relieve the pain, one should suspect aortic dissection.NSAID (nonsteroidal anti-inflammatory drugs) and selective cyclooxygenase II (COX-2) inhibitors are contraindicated (these drugs increase mortality in acute coronary syndromes).Nitrates cause vasodilatation by relaxing smooth muscle in arteries and veins. angor instable, NSTEMI, sous-décalage du segment ST, onde T négative. Tout d'abord, NSTEMI se produit lorsqu'une partie de l'artère du cœur est occluse par un caillot. Patient. Oxygen is also appropriate in patients with pulmonary edema, heart failure and mechanical complications (free wall rupture, ventricular septum defect, mitral prolapse) of NSTEMI or unstable angina.Pain activates the sympathetic nervous system which leads to (1) peripheral vasoconstriction, (2) positive inotropic effect and (3) positive chronotropic effect. The dose is titrated until symptoms are relieved or a maximal dose of 200–300 μg/min is reached.Nitrates should not be administered in (1) patients with hypotension, (2) suspicion of right ventricular infarction, (3) sever aortic stenosis, (4) hypertrophic obstructive cardiomyopathy or (5) pulmonary embolism. Similarly, loading doses greater than 320 mg do not confer any additional benefit, which is why a loading dose of 320 mg is recommended.Optimal antiplatelet effect requires addition of either ticagrelol, prasugrel or clopidogrel. Startin with oral metoprolol 25 mg four times daily is recommended. Combining aspirin with any of these is referred to as DAPT (dual antiplatelet therapy).


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