Cardiac causes of cardiac arrest Flashcards
What are the two options for coronary reperfusion?
- Percutaneous coronary intervention
- Fibrinolytic therapy
Within what timeframe should PCI be considered? Would fibrinolytic therapy be considered?
within 12 hours of the onset of chest pain if clinical or ECG evidence of ongoing ischaemia
Consdier fibrinolytic therapy if PCI cannot be acheived within 2Hr of pain onset
Describe antithrombotic therapy around the time of PPCI
- Aspirin load 300mg
- Platelet ADP receptor blocker load (Clopidogrel 300-600mg, ticagrelor 180mg, prasugrel 60mg)
- Heparin in cath lab
- sometimes will need glycoprotein IIb/IIIa inhibitor as well (tirofiban)
Describe antithrombotic therapy around the time of fibrinolysis
in addition to fibrinolytic agent give:
- Aspirin 300mg
- Clopidogrel 300-600mg/ticagrelor 180mg
- clexane/heparin/fondaparinux
What are the contraindications to fibrinolytic therapy?
Absolute:
- previous haemorrhagic stroke
- ischaemic stroke in last 6mo
- CNS damage or neoplasm
- surgery, head injury or trauma in last 3w
- active internal bleeding or GI bleeding in last month
- known or suspected aortic dissection
- known bleeding disorder
Relative:
- refractory HTN >180
- TIA in last 6mo
- on oral anticoagulation
- pregnant or <1w postpartum
- traumatic CPR
- non-compressible vascular puncture
- active PUD
- advanced liver disease
- IE
Describe the ECG changes seen with successful reperfusion therapy
- accelerated idioventricular rhythm
Immediate treatment for suspected ACS
- Aspirin 300mg
- GTN
- O2 PRN
- IV Opioids
What is a rescue PCI?
- PCI post failed reperfusion with fibrinolysis
What is facilitated PCI?
- fibrinolysis given before PPCI
not recommended
Treatment of NSTEMI
- IV heparin/SC LMW Heparin
- Aspirin 300mg then 100mg daily
- BB
- consider GTN IV
- Consider ACE I
- If going for angio +/- revascularization then:
Clopidogrel 300mg then 75mg daily
OR
Ticagrelor 180mg then 90mg BD
Should have angio within 72Hr and then PCI/CABG if indicated
What are the components of secondary prevention for ACS?
- Anti-thrombotic therapy Aspirin/Clopi/NOAC/Warfarin
- Preservation of LV function - ACEI
- beta-adrenoreceptor blockade
- reduction of cholesterol
- smoking cessation/diet/exercise
- antihypertensives
Describe the treatment of symptomatic bradycardia post AMI. Which type of infarct is this most common in?
-inferior AMI - excessive vagal tone and dysfunction of conductiuon system
-treat symptomatic bradycardia with atropine
- consider pacing if bradycardia and hypotension persist post atropine
AV block is usually transient and resolves post PCI
- AV block with anterior AMI has poor prognosis, usually has broad complexes and is resistent to atropine. usually needs PPM
