Management of MI Flashcards
Acute plaque rupture ACS is characterized clinically by
Unstable Angina, Stemi, Nstemi
MI classification
- Due to primary coronary event such as plaque erosion, fissuring, dissection
- Due to imbalance of O2 supply/demand. Secondary. coronary spasm, embolism, anemia, htn
- SCD (sudden cardiac death)
4&5. Associated with procedures
Describe enzyme markers
CK-MB elevates along with Troponin I. Ck-mb returns to normal after two days while troponin stays elevated for 2 weeks
what class of drugs are fibrinolytic agents
plasminogen activators
Difference between Rx of stemi and Nstemi
dont give fibrinolytics w/ nstemi. Dont put in stent immediately
how does adding clopidogrel to asa Rx change it
20% risk reduction. ie, for intracoronary clot formation, use antithrombin and antiplatelet
in what patient is GPiib/iiia therapy affective
TnT positive
when is early invasive strategy recommended
rEF, sustained VT, Elevated TnT or TnI, st depression, recurrent angina
list the seven types of antithrombotic therapies
ASA, UFH, LMWH, DTI, Penta, GPIIb/IIIa, ADP antagonist
why dont we use myoglobin as an enzyme marker
it is nonspecific
what are the general Rx guidelines for STEMI
Analgesics, nitrates, O2, beta blockers.
how long does it take before you see ischemia of endocardium? midmyocardium? transmural?
40 min, 3 hrs, 24 hrs
what are some pros and cons of fibrinolytics
Available, easy to use, rapid.
Stroke, hemorrhage, only 1/2 of pts achieve TIMI 3 flow, can be antigenic (streptokinase)
general recommendations for Rx of NSTEMI/UA
ASA, clopidogrel, heparin (exonaparin preferred over UFH), beta blocker, nitrates
who would you want to put on IIb/IIIa inhibitors?
NSTEMI/UA pts who are at high risk (+ECG, elevated troponins,etc)
