Chapter 56: management of STEMI Flashcards
what is a myocardial infraction
necrosis of the myocardium resulting form ischemia
what is STEMI
acute MI caused by complete interruption of regional myocardial blood flow
- causes ST segment elevation
Diagnosis of STEMI
- chest pain
- elevation of ST segment on ECG
- sweating, weakness, sense of impending doom
Biochemical markers for MI
- cardiac troponin I and cardiac troponin T
- MB isozyme of creatine kinase (CK-MB)
STEMI routine drug therapy
- oxygen
- acetylsalicylic acid
- morphine
- beta blockers: atenolol, metoprolol
- nitroglycerin
STEMI reperfusion therapy
- want to restore blood flow through the blocked coronary artery
- primary percutaneous coronary intervention (PCI) (angioplasty-stent)
- fibrinolytic (thrombolytic) therapy
Fibrinolytic (thrombolytic) therapy goal
to improve ventricular function, limit size of infract, and reduce mortality
Fibrinolytic (thrombolytic) therapy is most effects when
patient presents early; not given if pain has been present longer than 12 hours
- best if given during forst 4-6 hours
timely administration of fibrinolytic (thrombolytic) therapy =
opening of accluded artery in 80% of patients
what is the target time of fibrinolytic therapy
30 min target time
fibrinolytic therapy is best for patients younger than
75 years old
management of STEMI drugs
- unfractionated heprin
- low molecular weight heparin
- antiplatelet drugs
unfractionated heparin used for treatment
lasting less than 48 hours
low molecular weight heparin is used for treatment
loasting longer than 48 hours
antiplatelet drug examples
- clopidogrel [plavix]
- GP IIb/IIb inhibitors
- low dose acetylsalicylic acid (asprin)
Angiotensin-converting enzyme (ACE) inhibitors
- decrease short term mortality in all patients and long term mortality in patients with reduced left ventricular function
- reduce preload and afterload, promoting water loss and favorably altering ventricular remodeling
ACE inhibitors is recommended
for all patients in the absence of specific contradictions
treatment with ACE inhibitors should start within
25 hours of symptom onset
ventricular dysrhythmias frequently develop after
MI
complications of STEMI
- ventricular dysrhythmias
- cardiogenic shock
- heart failure and cardiac rupture can also occur
Secondary prevention of STEMI
risk factor reduction
- cholesterol control, smoking cessation, exercise, blood pressure control, diabetes control
what 4 drugs should be taken indefinitely after an MI
- beta blocker
- ACE inhibitor
- Antiplatelet drug/anticoagulant
- statin
