4 Acute Coronary Syndrome, part 2 Flashcards
Door-to-balloon (PCI) time for a patient who arrives at a PCI-capable hospital
≤90 minutes
Door-to-balloon (PCI) time for a patient who arrives at a non-PCI-capable hospital
≤120 minutes
If PCI cannot be accomplished within the recommended PCI timeframes, fibrinolysis should be given within:
(door-to-needle time)
≤30 minutes
Fibrinolytic therapy is indicated for STEMI patients if time from symptoms onset to treatment is:
<6 to 12 hours
Alteplase dose in STEMI
Body weight >67 kg:
15 mg initial IV bolus;
50 mg infused over next 30 mins;
35 mg infused over next 60 mins
Body weight <67 kg:
15 mg initial IV bolus;
0.75 mg/kg invused over next 30 mins;
0.5 mg/kg infused over next 60 mins
(max 100 mg)
Alteplase dose in Acute Ischemic Infarct
0.9 mg/kg IV, with a max dose of 90 mg
Administer 10% of the dose as a bolus over 1 minute,
with the remaining amount infused over 60 minutes.
Dose of Clopidogrel in ACS
STEMI:
Loading dose of 600 mg PO followed by 75 mg PO daily.
No loading dose is administered in patients >75 y/o receiving fibrinolytics.
NSTEMI/UA:
Loading dose of 300-600 mg PO followed by 75 mg/day
Dose of enoxaparin in ACS
STEMI:
30 mg IV bolus followed by 1 mg/kg SC every 12 hours
NSTEMI/UA:
1 mg/kg SC every 12 hours
Dose of nitroglycerin in ACS
Sublingual: 0.4 mg every 5 mins x 3 prn for pain
IV: start at 10 mcg/min,
titrate to 10% reduction in MAP if normotensive,
30% reduction in MAP if hypertensive.
In AMI, titrate IV nitroglycerin to BP reduction rather than to symptom (chest pain) resolution
Dose of morphine in ACS
2-5 mg IV every 5-15 mins PRN for pain
The early invasive approach depolyed in STEMI is recommended in NSTEMI patients only in those with:
refractory angina, or
hemodynamic instability, or
electrical instability,
risk for clinical events
AHA/ACC guielines recommend early (within 24 hours) invasive thearpy in UA/NSTEMI patietns with:
recurrent angina/ischemia
elevated cardiac troponins
new or presumably new ST depression
high-risk findings on noninvasive stress testing
depressed LV function
hemodynamic instability
sustained V tach
PCIs within the previous 6 months
prior CABG
If patients with UA/NSTEMI are hemodynamically unstable, guidelines recommend invasive strategy within ______
2 hours
Most common PCI
Coronary angioplasty with or without stent placement
alternatives: atherectomy and laser angioplasty
Mechanism of action of fibrinolysis
- Fibrinolytic agents are tissue plasminogen activators.
- Plasminogen, an inactive proteolytic enzyme, binds directly to fibrin during thrombus formation to form a plasminogen-fibrin complex.
- This complex incorporated into the clot is more susceptible than circulating plasma plasminogen to activation (thus, the concept that fibrinolytic agents are to a varying degree “clot specific”, promoting fibrin proteolysis).
