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Flashcards in Acute Coronary Syndromes II Deck (29):
1

Paradigm for treating STEMI

"Time is muscle" Goal is immediate restoration of blood flow to occluded vessel.

2

Therapy that all MI patients get

Anti-coagulation, anti-platelet, anti-ischemic, adjunctive

3

Anti-ischemic Rx

Beta-blockers (relieve ischemic pain by decreasing cardiac work and oxygen demand. Reduce infarct size and arrhythmias. Mortaility benefit.)

Nitrates (enhance blood flow by coronary vasodilation and decrease preload. But don't give to STEMI patients early, or with RV infarct)

CCB (NonDHP's reduce HR and contractility. No mortality benefit in ACS.)

4

Antithrombotic therapy

Antiplatelets and anticoagulants.

Antiplatelets decrease platelet aggregation and are effective in arterial circulation.

Anticoagulants limit blood from clotting.

5

Aspirin

Effective across entire spectrum of ACS. Should be given as soon as possible to all patients with suspected ACS. Has rapid anti-platelet effect and reduces coronary occlusion and recurrent ischemic events after fibrinolytic therapy.

6

Clopidogrel/Prasugrel

Thienopyridine derivative that is an IRREVERSIBLE inhibitor of the P2Y12 Receptor. Indicated in all patients with USA/NSTEMI unless surgery planned. Takes 5 days to recover.

Prasugrel has more even effect. Newer generation.

Lots of interindividual variability in response to clop.

7

Glycoprotein IIb/IIIa inhibitors

Super potent, inhibit the final common pathway of platelet aggregation, but use has declined with antiplatelet drugs.

8

Anticoagulation therapy

Heparin
Bivalirudin
Factor Xa inhibitor

9

Heparin

Standard anticoagulant

10

Bivalrudin

Direct thrombin inhibitor. Can be used instead of heparin

11

Factor Xa inhibitor

Similar efficacy to LMWH but less bleeding

12

How does heparin work?

Unfractionated heparin: Binds to antithrombin, causes conformational change that causes it to bind to thrombin more avidly, also factor Xa.

LMWH: Binds to antithrombin, binds to just factor Xa more avidly.

13

Conservative treatment of USA/NSTEMI patients

Medications alone with angio/revasc only if clinical worstening or evidence of ischemia

14

Invasive treatment of USA/NSTEMI patients

Urgent cardiac cath.

15

How to determine risk of USA/NSTEMI

TIMI risk score. Risk of adverse outcomes increases with each point

16

What is ideal time to start PCI with STEMI?

<90 minutes.

17

Can lytic agents be used for coronary artery occlusion

Yeah! TPA is good.

18

What is better for STEMi in high risk patients: PCI or Fibrinolysis?

PCI

19

When is fibrinolysis preferred to PCI for STEMI?

If there is a huge delay to get to a cath lab.

20

If presentation is < 3 hours and there is no delay to an invasive strategy, what should be done?

No preference for either.

21

Why are ACEi given in MI

Prevent ventricular remodeling.

Greatest benefit in anterior MI and systolic dysfunction

22

What is a major complication of MI?

Arrhythmias.

23

VFIB

Can cause sudden cardiac death early in MI, but can be aborted with rapid defibrillation. Take to CCU

24

Supraventricular arrhythmias

Bradycardia, tachycardia, afib

25

Pseudoaneurysm

Hole causes blood to pool outside LV. Communication between LV and pericardium

26

True aneurysm

Develop months to weeks after MI. No communication between LV cavity and pericardium. Can cause arrhythmia. Tissue bulges

27

Papillary muscle rupture

If RCA occluded, papillary muscle can rupture.

28

Pericarditis after MI

Acute can occur if inflammation extends from myocardium to pericardium

29

Dressler syndrome

Autoimmune process that happens 6-8 weeks post MI. Causes pericarditis,