ACS/AMI IV Flashcards
in post-STEMI pt’s, which media indicated for “infarct size limitation?”
BB
can you give clopidogrel at the time of PCI?
yes
which trial showed a benefit with prasugrel over clopidogrel for CV death/MI?
TRITON TIMI 38
which trial showed that ticagrelor pt’s had less IST than clopidogrel?
PLATO
When can you give prasugrel after fibrinolytic therapy?
After 24h
which trial showed that clopidogrel lowers CV death/MI/urgent revascularization/recurrent ischemia after lytic therapy?
CLARITY TIMI 28
what are the Class I recommendations for GP IIbIIIa inhibitors post STEMI and PCI?
none
what is the strongest rec class for GPIIBIIIa inhibitor use?
Class IIa
if pt is given fibrinoytic Rx for STEMI, how long do you continue A/C for?
at least 48h, preferrably for entire hospitalization, or until PCI
which Anticoagulants should you use if need them for >48h
lovenox
fondaparinux
(avoid HIT)
what did HORIZONS-AMI trial show for bivalirudin vs hep + GPIIbIIIa inhibitors?
that bivalirudin alone decreased 30d mortality and had less major bleeding.
although bivalirudin alone is superior to Hep + GP2b3a, why was there an early hazard with it?
due to no preload of thienopyridine
name 5 factors that increase the risk of cardiogenic shock during STEMI
age > 70
HR < 60 or HR>110
late stemi
SBP < 120
when are ACEI a Class I rec in AMI?
STEMI
AMI w/ EF<40%
list the 5 known mech complications of AMI
shock RV infarct free wall rupture VSD pap m. rupture
Dr. Killip classification
I - no S3 or rales
II- basilar rales not above 1/2 lung fields
III- rales above 1/2 lung fields
IV- cardiogenic shock
Bezold-Jarish reflex
HoTN/bradycardia s/p RCA PCI
hemodynamic criteria for shock
PCWP > 15
CI < 2.2
what do you have to rule out before diagnosing cardiogenic shock?
hypovolemia
brady or tachyarrhythmias
Bezold-Jarish reflex
incidence of cardiogenic shock post MI?
10%
mortality of ? in cardiogenic shock with conservative therapy?
80%
*does thrombolytic therapy alone in cardiogenic shock improve survival?
No!
when is non culprit PCI ok to do?
shock
5 causes of cardiogenic shock in Shock Trial Registry (in order of most common to least)
LV failure Acute MR VSD RV infarct Tamponade
Shock trial results
emergency early revasc (PCI or CABG) in AMI and shock reduced mortality by 20% c/t thrombolysis or just medical stabilization at 6 months
in Shock trial, which subset of pt’s did worse with emergency revascularization?
age > 75
from the Shock trial, what is the window of time to revascularize in STEMI w/ shock? (Class I)
36h
in STEMI and shock, should outside institutions give both thrombolysis and IABP?
yes
in whom do you suspect RV infarction?
inferioir MI and HoTN
ekg in RV infarction
ST elev in V3R and V4R