Acute Coronary Syndrome (ACS) Flashcards
Mortality reduction of Aspirin for myocardial infarction? what about for unstable angina?
25% and 50% reduction respectively.
Within what time frame is angioplasty performed to reduce mortality?
w/in 90 min of arriving to ED.
If angioplasty cannot be done w/in 90 min what do you do?
Give thrombolytics w/in 30 min of arrival to ED
Indication for thromboytics?
Cannot perform angioplasty w/in 90 min.
Chest pain of >12hrs with ST segment elevation in two or more leads.
New LBBB.
Do beta blockers lower mortality? if so, when?
Yes at any stage/time.
When do Angiotensin Converting Enzyme (ACE) inhibitors have a mortality benefit?
When there is a left ventricular dysfunction or systolic dysfunction.
When to give statins in ACS?
To all patients regardless of EKG results, troponin level, or CK-MB level.
When is prasugrel included in the treatment?
Only if the patient is going to undergo angioplasty.
Therapy of ACS that always reduces mortality? (meds, treatment list)
Aspirin Thrombolytics Primary angioplasty Metoprolol Statins Clopidogrel, prasugel, or ticagrelol
Therapy of ACS that reduces mortality if ejection fraction is low?
ACE & ARBs
Therapy of ACS that reduces mortality if ST depression?
Heparin
When is prasugrel, clopidogrel, or ticagrelor the answer? What is ticlopidine associated with?
When there is aspirin allergy, the patient is in acute MI (added to aspirin), or if the patient is going to undergo angioplasty. Do not use with stroke because increases CNC bleeding.
Ticlopidine causes neutropenia.
When is verapamil or diltiazem the answer?
When patient cannot take beta blockers: asthma, cocaine induced chest pain, coronary vasospasm/prinzmetal angina.
Cocaine (an stimulant) and beta blockers are usually opposites in mechanism when taken alone but when taken together cause a synergistic effect, more vasoconstriction (cocaine) = less oxygen = ACS worsens.
When is lidocaine or amiodarone used in ACS?
With VT or ventricular fibrillation.
When is pacemaker the answer?
Third degree AV block Bradycardia Mobitz type 2 Second degree AV block Bifascicular block New LBBB
