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Flashcards in Acute Coronary Syndromes Deck (19):
1

acute coronary syndromes

represent the continuum of accelerating, unstable angina to non ST segment elevation infarction

pathogenesis - interaction of thrombosis and inflammation, acute rupture or erosion of a coronary atherosclerotic plaque with consequent intravascular clot formation at the site of plaque instability

2

classification of residual flow after obstruction

total obstruction without adequate residual flow - usually results in STEMI

total obstruction with adquate residual flow

partial obstruction without adequate residual flow - usually results in NSTEMI

partial obstruction with adequate residual flow

3

acute care for ACS

restore blood flow as soon as possible

stop intravascular clot formation

relieve pain

reduce ischemia

control spasm

4

abciximab

hybrid antibody that irreversibly blocks the IIb/IIIa receptors

5

tirofiban and eptifibatide

small molecules that reversibly block IIb/IIIa receptors

6

long-term treatment of ACS

prevent recurrence - use aspirin, statins, ACE inhibitor, angiotensin receptor antagonists, and beta blockers

prevent left ventricular remodeling - requires routine use of an ACE inhibitor or ARB

7

class 1 MI

spontaneous MI related to ischemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection

8

class 2 MI

MI secondary to ischemia because of imbalance in oxygen levels due to coronary spasm or embolism, arrhythmias, hypertension, or hypotension

9

class 3 MI

sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggesting ischemia with new ST-segment elevation

new LBBB or fresh coronary thrombus

10

class 4a MI

MI associated with PCI

11

class 4b MI

MI associated with documented in-stent thrombosis

12

class 5 MI

MI associated with CABG surgery

13

clopidogrel and prsugrel (also ticagrelor)

thienopyridines that block the ADP pathway of platelet activation

14

pros of fibrinolytic reperfusion

universally available

ease of use

rapid administration

15

cons of fibrinolytic reperfusion

hemorrhave/ICH/stroke

reocclusion/recurrent ischemia

contraindications

only 54%-60% of patients achieve TIMI grade 3 flow

16

currently available fibrinolytics

streptokinase

anistreplase

alteplase

reteplase

tenecteplase

17

disadvantages of ungractionated heparin

heparin is neutralized by platelet factor 4, which is released by platelets on aggregation

heparin is bound non-specifically to plasma proteins to a different degree in different patients

heparin cannot neutralize thrombin bound to fibrin

18

fondaparinux

direct factor Xa inhibitor

19

bivalirudin