Acute Coronary Syndromes Flashcards
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
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
acute care for ACS
restore blood flow as soon as possible
stop intravascular clot formation
relieve pain
reduce ischemia
control spasm
abciximab
hybrid antibody that irreversibly blocks the IIb/IIIa receptors
tirofiban and eptifibatide
small molecules that reversibly block IIb/IIIa receptors
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
class 1 MI
spontaneous MI related to ischemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection
class 2 MI
MI secondary to ischemia because of imbalance in oxygen levels due to coronary spasm or embolism, arrhythmias, hypertension, or hypotension
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
class 4a MI
MI associated with PCI
class 4b MI
MI associated with documented in-stent thrombosis
class 5 MI
MI associated with CABG surgery
clopidogrel and prsugrel (also ticagrelor)
thienopyridines that block the ADP pathway of platelet activation
pros of fibrinolytic reperfusion
universally available
ease of use
rapid administration
cons of fibrinolytic reperfusion
hemorrhave/ICH/stroke
reocclusion/recurrent ischemia
contraindications
only 54%-60% of patients achieve TIMI grade 3 flow
