Revascularization Flashcards
Indications for CABG
This patient has severe 3-vessel coronary artery disease and severe left ventricular systolic dysfunction. Such patients (regardless of symptoms) should undergo revascularization for mortality benefit. Moreover, patients with diabetes mellitus and multivessel coronary artery disease generally should be strongly considered for surgical revascularization as opposed to multiple stents.
1999 Recommendations from ACC/AHA:
1. Significant left main coronary artery stenosis.
- Left main equivalent: significant (70 percent) stenosis of the proximal left anterior descending (LAD) and proximal left circumflex arteries.
- Three-vessel disease.
- Two-vessel disease with significant proximal LAD stenosis and either ejection fraction < 50% or demonstrable ischemia on noninvasive testing.
- One- or 2-vessel stenosis without significant proximal LAD stenosis, but with a large area of viable myocardium and high-risk criteria on noninvasive testing.
- Disabling angina despite maximal noninvasive therapy, when surgery can be performed with acceptable risk.
Vessel for an acute anterior wall MI?
acute anterior wall myocardial infarction (MI), which is supported by his ECG findings. The anterior wall of the left ventricle receives its arterial supply from the anterior branch of the left coronary artery (left anterior descending artery [LAD]). Occlusion of this vessel results in acute anterior wall MI, which is represented by ECG findings, including ST elevation in leads V1-V6, I, and aVL (aka: high-lateral leads); with reciprocal ST depression in leads II, III, and aVF (also known as the inferior leads). Additionally, involvement in leads I and aVL is common when the diagonal branches of the LAD are large and feed the lateral ventricle. If the septal perforators are involved, then leads V1 and V2 will also be elevated. The LAD is a large artery, and in some cases, also feeds the inferior portion of the ventricle, in which case there can be elevations in the inferior leads as well. Treatment is with percutaneous revascularization if the patient presents within the therapeutic window. Otherwise, treatment with anticoagulation, aspirin, morphine, oxygen (if hypoxic), beta-blocker, and an angiotensin-converting enzyme inhibitor is recommended.
Why do we give beta blockers after an MI?
The most common cause of death in the first 24 hours following a STEMI/NSTEMI is an arrhythmia such as ventricular fibrillation. Oral beta-blockers have been shown to reduce the risk of death after acute MI (STEMI or NSTEMI) by 23% and should be administered as soon as possible.
