Non Stemo Flashcards
Low risk patients
Stress in 72 hours if EKG and the markers are negative
Incidence
Decreasing incidence mi and STEMI but non STEMI rates are going up
Old age
High risk
Short term high risk of death
Accelerating chest pain CHF Dynamic STT changes VT Positive enzymes
Timi risk Age 65 or older 3 risk factors Prior stenosis 2 anginal events St deviation Asa use Elevated markers
0-- 4.7% 2-8% risk 3-13% 4-20% 5-26% 6-41%
Grace scale
1-88 less than 3%
High 119-263 more than 8%
Tropinin
Not normal to have a detectable levels
50% of the time mom cardiac
USA
Favors early invasive therapy
Angio max
2a in Unstable angina
Triton study
Less mi and stroke and less stent thrombosis with effient
Accoast study
Pre-treating with effient upstream no benifit
Trilogy acs
Effient better than plavix
Elective pci use pkavix only STEMI all 3 can be used After lytics only plavix Acs pretreat plavix only either 600 or 300. Triple therapy plavix only
Surgery early after pci
Switch all to plavix
2b 3a
Only high risk for early invasive
Avoid upstream in low risk
Avoid in medical therapy
Avoid with angio max
Anticoag
Enoxeparin better than UFH
Causes of tropinin elevation
PE CHF Sepsis Rf Chronic cad LVH
Guide lines for aggressive strategy
For USA / NSTEMI
Recurrent angina at rest Pci with in 7 mos High timi score Low EF O
Timac trial
Aggressive treatment is better in high risk
Prasugrel
Lower stent thrombosis than plavix
Ticagrelor
Less bleeding
A to Z trial
Less bleeding with Enoxeparin
Acuity trial
Angio max is better than angio max and 2 b 3a or heparin and 2b3a
Anti ischemic class 1 On going cp
Bed rest Nitro Morphine Bb first 24 hours No iv bb Acei for EF <40 Or ARB
Statin
Higher doses are better
mI and RBBB
Bad sign
At elevation in AVR
Prox lad or LM lesion
CFR
2.0 to 2.5 is normal
