Cardiovascular Conditions: Acute Coronary Syndromes Flashcards
Risk factors for acute coronary syndrome
Men > 45 or Women > 55
FH o1st degree relative coronary event before 55 (men) and 65 (women)
Smoking
HTN
Known CAD
Dyslipidemia
Diabetes
Chronic stable angina
Lack of exercise
Excessive alc
Classic ACS symptoms
Chest pain > 10 min
severe dyspnea
diaphoresis
pain can radiate down arms/back/neck/jaw/epigastric region
females, elderly + diabetics less likely to experience classic symptoms
NTG dose for ACS?
1 dose every 5 min, for up to 3 doses to relieve chest pain
if not relieved or worse 5min after first dose call 911
non-ST segment elevation cute coronary syndromes (NSTE-ACS) treatment
either medications or PCI
STEMI treatment
require blocked arteries be opened as quick as possible with PCI or fibrinolysis
PCI - within 90 min of hospital arrival or 120min within 1st contact
Fibrinolysis = if cant do PCI ( 120min) , should be done within 30min of arriving to hospital
MONA-GAP-BA
Morphine
Oxygen
Nitrates
Aspirin
GPIIb/IIIa antagonist = Abciximab/Eptifibatide/Tirofiban (anti platelet)
Anticoagulant
P2Y12 inhib = clopidogrel
(given within 24hrs prn, continue outpatient)
Beta blockers
ACE inhibitors
When should you not use IV NTG?
SBP < 90mmHG, HR < 50 bpm or pt has right ventricular infarction
Which meds shouldn’t be used in ACS acute setting?
NSAID = inc mortality and other stuff
IR nifedipine = inc mortality
P2Y12 inhibitor dosing
Loading dose at start, then go to maintenance dose
usually used as DAPT with Aspirin
Clopidogrel warnings
dont use 5 days before elective surgery
Dont use with omeprazole or esomeprazole
Prasugrel (Effient) warnings
CI = serious bleeding, hx of TIA or stroke
Stop 7 days prior to elective surgery
Dont use if CABG likely
Ticagrelor (Brillinta) warnings
dont exceed maintenance dose of 100mg/day aspirin if taking
stop 5 days before any surgery
dont sue if CABG likely
GIIb/IIa receptor angagonists
Abciximab
Eptifibatide
Tirofiban
GIIb/IIa receptor angagonists CI
platelets < 100K
Hx of bleeding predispostion
Active internal bleed
sever uncontrolled HTN
Recent major surgery/trauma (4 wk Tirofiban, 6wk others)
Hx of stroke 2yrs (abciximab) n hx stroke w/in 30 days or any history of hemorrhagic stroke (eptifibatide)
How do fibrinolytics work?
converting plasminogen to plasmin
Fibrinolytics are used only for…
STEMI
should be given 30min within hospital arrival
Alteplase info
recombinant tissue plasminogen activator (tPA)
Alteplase Contraindications
Active internal bleeding
Hx of recent stroke
prior intracranial hemorrhage
severe uncontrolled hypertension
** different CI when using for stroke **
