Introduction

Acute coronary syndrome is composed of patients with

1] acute myocardial infarction with ST segment elevation on their presenting electrocardiographic changes [ECG]

2] NSTEMI

3] Unstable Angina

ST segment elevation myocardial infarction have been diagnosed on the basic traid : chest pain, electrocardiographic changes, elevated plasma enzyme activity.

Most common symptom:

1] Chest pain- most common presenting complaint in STEMI patient which is deep and visceral commonly described as heavy, squeezing & crushing

2] ECG – it is sensitive for detecting myocardial ischemia & infarction

A] New Q waves

B] New or presumably new ST-T segment elevation or depression after J point in two consecutive leads

C] Complete left bundle branch block in appropriate clinical setting

D] The ECG diagnosis of right ventricular (RV) occurs in the presence of inferior left ventricular infarction

E] Posterior wall MI is indicated by ST-segment elevation in posterior leads v7-9.

3. Serum cardiac biomarkers: Certain cardiac markers (CPK-MB/ Troponin-T and I) are released into the blood in large quantities from necrotic heart muscle agree myocardial infarction.

• The Killip’s classification:
• Killip classified patients with acute MI into 4 classes depending on the clinical manifestations of cardiac failure.
• Class 1: No signs of pulmonary or venous congestion
• Class 2: Moderate heart failure i.e. rales at lung bases, s3 gallop, tachypnea or signs of failure of right side of heart including venous and hepatic congestion
• Class 3: Severe heart failure, pulmonary edema
• Class 4: Shock with systolic pressure

 Serum Uric Acid

• It reflects circulating xanthine oxidase activity and oxidative stress production. It is defined in patients who have congestive heart failure.

Serum uric acid levels were noted in patients with acute MI and correlation with Killip’s classification was studied, and at the same time, it was decided whether it affects mortality in such patients.

1. Cannon C, Braunwald E. Unstable angina and non-ST-elevation myocardial infarction. In: Kasper DL, Braunwald E, Fauci H, Longo CA, Jameson JL, editors. Harrison’s Principles of Internal Medicine. 18^th Chicago: McGraw-Hill; 2005.
2. Strasak A, Ruttmann E, Brant L, Kelleher C, Klenk J, Concin H, et al. Serum uric acid and risk of cardiovascular mortality: A prospective longterm study of 83,683 Austrian men. Clin Chem 2008;54:273-84.
3. Cicoira M, Zanolla L, Rossi A, Golia G, Franceschini L, Brighetti G, et al. Elevated serum uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy. Am Heart J 2002;143:1107-11

Dr M.G.K. Pravallika Santoshini

Department of General Medicine

GEM Ssrikakulam