B.7 STEMI. TX Flashcards
B.7 STEMI. TX
Monitoring
- Serial 12-lead ECG
- Continuous cardiac monitoring
- Serial serum troponin testing
B.7 STEMI. TX
Name the Drugs
- Sublingual or IV Nitrate
- Nitroglycerin
- Isosorbide dinitrate (ISDN) - Morphine
- IV or subcutaneous (SC) - Beta Blockers
- Specific drugs may include Metoprolol, Atenolol, Carvedilol, etc. (not specified) - Statins
- High-intensity statins (e.g., Atorvastatin, Rosuvastatin, etc.) - Loop Diuretic
- Furosemide (Lasix)
B.7 STEMI. TX
Sublingual or IV Nitrate
For relief of chest pain
Does not improve prognosis
Contraindications: recent myocardial infarction (due to risk of hypotension), hypotension, or PDE 5 inhibitor use (within the last 24 hours)
B.7 STEMI. TX
Morphine
Morphine IV or SC (3–5 mg)
Administer only if the patient experiences persistent chest pain or severe anxiety related to myocardial events
Use cautiously to avoid worsening complications (e.g., hypotension, respiratory depression)
B.7 STEMI. TX
Beta Blocker
Recommended within the first 24 hours
Avoid in patients with signs of acute heart failure, arrhythmias, or high-risk for cardiogenic shock (e.g., large left ventricular infarct)
B.7 STEMI. TX
Statins
Initiate high-intensity statin therapy regardless of baseline cholesterol, LDL, and HDL levels
B.7 STEMI. TX
Loop Diuretic (e.g., Furosemide)
Administer if the patient exhibits pulmonary edema or signs of heart failure
B.7 STEMI. TX
Supportive Care
IV Fluids (e.g., normal saline)
Administer to patients with inferior myocardial infarction (MI) leading to right ventricular (RV) dysfunction.
Oxygen
Provide only if the patient shows signs of cyanosis, severe dyspnea, or SpO2 levels below 90%.
B.7 STEMI. TX
Treatment of Unstable Angina/NSTEMI
Dual Antiplatelet Therapy: Initiate Immediately!
- Aspirin: Administer a loading dose of 300 mg.
- ADP Receptor Inhibitor: Use either clopidogrel or ticagrelor (loading dose of 600 mg).
- Continue dual antiplatelet therapy for a minimum of 12 months if percutaneous coronary intervention (PCI) with drug-eluting stents (DES) was performed.
Anticoagulation:
- Use Heparin or enoxaparin.
- Maintain treatment for the duration of hospitalization or until PCI is performed.
B.7 STEMI. TX
Unstable Angina/NSTEMI Risk Stratification
GRACE Score
- Purpose: A scoring system to evaluate patients diagnosed with acute coronary syndrome (ACS) to estimate in-hospital and 6-month to 3-year mortality rates.
- Factors Considered:
- Age, Heart Rate (HR), Systolic Blood Pressure (SBP), Creatinine Level, CHF
- Cardiac arrest during admission
- ECG ST segment abnormalities
- Changes in cardiac biomarkers
B.7 STEMI. TX
Results GRACE score
Individuals who did not meet the criteria mentioned above should undergo an elective angioplasty procedure within approximately one week.
