Acute Coronary Syndrome Part 2 Flashcards
What different life factors give points in the TIMI risk scores?
- over 65 y/o
- more than 3 risk factors for CAD
- prior coronary stenosis
- > 50% ST deviation on an ECG
- more than 2 anginal events in prior 24 hours
- use of aspirin in prior 7 days
- elevated cardiac biomarkers
What are some other high risk factors for ACS?
- hemodynamic instability
- refractory angina
- recurrent angina or ischemia at rest
- signs and symptoms of HF
- sustained VT
- ECG changes (new ST depression)
- prior PCI/CABG
What patients are generally referred for a CABG?
- high risk patients with multi-vessel disease may be referred for a CABG (hold DAPT 5-7 days prior to surgery if possible)
When is an angiography/PCI revascularization indicated in patients?
for high risk patients with a TIMI risk score of >2, or in the presence of other high risk characteristics
UN/STEMI patients who underwent early invasive strategy with PCI should receive what?
- DAPT (as would a STEMI patient receive)
How long should DAPT therapy be recommended in all ACS patients?
- recommend DAPT therapy for 1 year in all ACS patients
over 1 year therapy is controversial
How long should DAPT therapy be recommended in all ACS patients?
- recommend DAPT therapy for 1 year in all ACS patients
over 1 year therapy is controversial
If a patient is at very high risk of having another infarction, what should be used: clopridogrel or ticagrelor?
- ticagrelor
there is a reduction in endpoint death from CV causes, nonfatal MI or stroke in the ticagrelor group
What are GP IIb/IIIa inhibitors?
they are potent anti-platelet agents
Describe the action of GP IIb/IIIa agents?
- they block the binding of fibrinogen to GP IIb/IIIa receptors on the platelet surface, therefore inhibiting platelet aggregation
What are examples of the GP IIIb/IIIa receptor antagonists?
- abciximab, epifibatide, tirofiban
When do GP IIb/IIIa inhibitors have benefit?
- they have demonstrated benefit in reducing death/MI in patients who have undergone PCI (early invasive strategy)
What anticoagulant is the standard to give?
- LMWH is the standard to give in patients (long acting and has renal elimination however- disadvantage)
What needs to be monitored in patients receiving anticoagulant therapy?
- need to monitor signs of bleeding, Hbg and platelets
What is the action of fondaparinux?
- indirect acting factor Xa inhibitor
- we do not usually give this unless the person is at a very high risk of bleeding
What are the goal of adding adjunct therapy to anticoagulants?
- reduce the risk short term and long term complications associated with ACS
- slow the progression of coronary heart disease and minimize the risk of future cardiovascular events and other morbidities
- improve mortality and quality of life
What medications generally have to be used for life after an MI?
- ASA, ticagrelor/clopridogrel and ACE inhibitors are all for life
How long do beta blockers need to be taken after an event?
- for 3-4 years
What 4 medications should be started before a person leaves the hospital for long term risk reduction?
- ASA, beta blockers, statins, ACEI (all 4 provide a cumulative risk reduction of 75%)
What is the role of omega-3 fatty acids in risk reduction?
- unclear if omega 3 fats alter the total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population
What vitamins/supplements are NOT recommended in preventing heart disease
- vitamins A,C,E and beta caroteine
- folic acid either alone or in combination with vitamin B6 or vitamin B12
Hormone therapy is not recommended in post menopausal women post MI because of what?
- they may increase CV risk
What else should be avoided post MI?
- NSAIDs, including selective COX2 inhibitors should be avoided if possible
What medication should be avoided in those that are active, ongoing users of cocaine or methamphetamine?
- beta blockers (should be avoided due to the risk of potentiating coronary spasm)
