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Test1_Chapter 26C

Perfusion/ACS-Chapter 26

QuestionAnswer
Acute Coronary Syndromes NSTEM or STEM
Non-ST-segment Elevation ACS Unstable Angina or NTE acute MI
ST segment elevation ACS STE Acute MI
Systoms of ACS Anginal chest pain at rest, new onset, may radiate or increasing angina. May be associated with diaphoresis, dyspnea, N/V
EKG STE-ACS Must have 2 or more ST elevations in 2 contigous leads AND either >0.2mV (mm) in leads V1, V2, V3 or >0.1mV in other leads
EKG NSTE-ACS ST segment depression>0.1mV in 2 or more contiguous leads or T-wave inversion> 0.1mV
EKG Anterior Infarct Q in V1, V2, V3, or V4
EKG Posterior Infarct Large R in V1, V2, Maybe Q in V6
EKG Laterial Infarct Q in I, AVL
EKG Inferior Infarct Q in II, III, AVF
Troponin I and T Draw lab after 6 hours (then every 8) and need only 1 value within 24 hrs to confirm DX
CK-MB Draw lab after 6 hours (then every 8) and need 2 values above upper limit wiithin 24 hrs to confirm DX
AGE65-74 -TIMI RISK for STEMI ACS 2 points
Age > 75y/o TIMI RISK for STEMI ACS 3 points
SBP,100mmHgTIMI RISK for STEMI ACS 3 points
HR>100 bpm TIMI RISK for STEMI ACS 2 points
HF class II-IV TIMI RISK for STEMI ACS 2 points
Anterior ST segment or Left ventricular bundle branch block TIMI RISK for STEMI ACS 1points
DM or HTN or Angina TIMI RISK for STEMI ACS 1 points
Time to TX > 4hrs TIMI RISK for STEMI ACS 1 points
Weight <67 kg TIMI RISK for STEMI ACS 1 point
Age >65 y/o TIMI RISK for NSTEMI ACS 1 point
> 3 or more risk for CAD TIMI RISK for NSTEMI ACS 1 point
Prior Hx of CAD TIMI RISK for NSTEMI ACS 1 point
ASA within the past 7 days TIMI RISK for NSTEMI ACS 1 point
> 2 anginal events w/in last 24 hrs TIMI RISK for NSTEMI ACS 1 point
St-segment deviation TIMI RISK for NSTEMI ACS 1 point
Elevation of Biochemical markers TIMI RISK for NSTEMI ACS 1 point
Non-STEMI High risk 5-7 points
Non-STEMI medium risk 3-4 points
Non-STEMI low risk 0-2 points
STEMI mortality Risk 2% vs points 0 points
STEMI mortality Risk 7% vs points 7 points
STEMI mortality Risk 35% vs points >8 points
EKG STEMI treatment-All IV Line, O2, ASA, Plavix, SL NTG, IV NTG, BB, Statin, ACE if anterior, previous MI Heparin, PCI or fibrinlysis
STEMI or NSTEMI ASA dose acute 162-325mg PO chew or 300mg PR(only STEMI)
Plavix dose acute 300mg PO
IV NTG dose STEMI or NSTEMI 5-10mcg/kg/min titrate up 5mcg/kg/min to max 200 mcg/Kg/min
Metoprolol dose acute 5mg IV push over two minutes, 3 doses, then 50mg PO Q6-8hr
Statin dose high dose Atorvostatin 80mg QD
ACE dose lisinopril 2.5-5.0 then 10-200mg if anterior infarction, or previous MI
Aldosterone Antagonist Use if LVEF<40%, HF, or DM within the first 24 hours
Aldalactone 25-100 mg PO QD
Inspra 25-50 mg PO QD
Heparin dose acute STEMI 60U/kg bolus then 12U/Kg/Hr check aPTT 1.5-2.5 above normal (50-70)
enoxaparin STEMI 30mg IV bolus then 1mg/kg/ SC
STEMI <12 hours Reprofusion therapy PCI (stent) ,Abciximab,ASA, Heparin, Plavix
Abciximab dose STEMI (PCI) 0.25mg/kg bolus 10-60min before PCI then 0.125mcg/kg/min for 12 hours
ASA dose acute STEMI (PCI) 300-325mg 2-24 hours before procedure
Heparin dose STEMI (PCI) 70-100U/Kg
Plavis dose acute STEMI (PCI) 300-600mg PO at least 6 hours prior to PCI and/or IIb/IIIa inhibitor
ASA chronic dose 75-162mg PO indefintely
Plavix chronic dose 75 mg PO indefintely
Within 30 minutes of presenting to Hospital Abciximab + plavix
STEMI Within 90 minutes of presenting to the hospital PCI
STEMI >12 hours Stress test, PCI, or CABG, or fibrinlysis
Primary PCI-STEMI 90% of occluded infarct opened
Fibrinlysisis-STEMI 60% occulded infarct opened
NSTEMI acute IV line, O2, ASA, PLavix, SL, NTG, IV NTG, IV BB, Statin, UFH or enoxaparin
NSTEMI NO PCI no further treatment
NSTEMI <12 hours PCI ASA, Abiciximab, plavix
Bare metal stent Can lead ro restenosis (scab) 1 month325mg ASA, , 75mg Paxil
Drug eluting stent 3 month 325 mg ASA, 75 mg paxil
Brachytherapy 6 months 325 mg ASA, 75 mg paxil
Canidates for fibrinolytic Therapy Contraindications: Prior ICH, cerebral vascular lesions, malignant intracranial neoplasm, ischemic stroke w/in 3 months, severe facial trauma w/in 3 months, active bleed
Fibrinolysis Prefereed if Early presentation (<3 hrs), invasive strategy not an option(Operater ,75 per y, or team ,36 per y), Delay to invasive strategy
Highest risk of bleed Age, female, low body weight
ISIS-2 value of ASA, 160mg acute (chew)
ISG Alteplace (more stroke) and stroptokinase (more bleed)
ISIS-3 Duteplace (more stroke) Heparin (more bleed)
Gusto Flawed study, Combination Alteplace + strepotkinase (more stroke)
Gusto III No different between Alteplace (tPA) and Recteplace (rPA) for stroke
Assent -2 Tecnecteplace (TNK) fewer bleed, less specificity, more intracrainal and stroke
Gusto V Retecplace (rPA) +abciximab +heparin had higher risk of bleeding complications
Asscent 3 Tececteplace and enoxaparin increased benefit less reinfarct, refractory ischemia with combination product
EPIC Abciximab 13% reduction at 3 years, overall 60% reduction in mortality
EPILOG Abciximab +low dose weight heparin Decrease bleed
PRISM Combo of Heparin, Tirofibran reduced death, But Tirofibran alone increased mortality
PURSUIT Eptifibatide better than placebo
EPSIRIT Eptifibatide + IIb/IIIa inhibitor reduced mortality 47%
Gusto IV Abciximab infusion 24hr highest decrease in death or reinfaction
Created by: jhrobins99