When do you not give nitrates in a patient with STEMI
When ecg shows inferior STEMI as they may precipitate severe hypotension
Stepwise management of a patient presenting with Angina symptoms
-Stabilise ABCs, IV access, attach monitors
- O2 titrated to Sats 94-98%. Hyperoxia can be harmful in ACS.
- ANTI-PLATELET THERAPY:
Aspirin 300mg stat chewed, then 150mg daily.
It blocks platelet activation by limiting TXA production via the cyclooxygenase pathway.
↓ mortality by 25%
Clopidogrel (Plavix) 300mg stat, then 75mg daily if aspirin allergy - NITROGLYCERIN:
No demonstrable survival benefit with NSTE-ACS.
Helps with vasospasm.
Don’t give if contra-indicated.
Isordil 5mg SL or Tridil infusion
MORPHINE:
For pain.Give small,regular IV doses.
Retrospective data suggests ↑ morbidity among NSTE-ACS patients.
- β-BLOCKERS:
Start within 24hrs of presentation.
Avoid in CCF, low cardiac output states. - ANTI-COAGULATION:
LMWH: Enoxaparin (Clexane) - 1mg/kg SC 12hourly.No monitoring necessary.
UFH: Heparin - less effective than clexane. Need to monitor PTT
List 4 early complications of Acute coronary syndrome (NSTEMI or Unstable Angina)
- Arrhythmia eg. VF,VT,AF,accelerated idioventricular rhythm,AV block,etc.
- Acute heart failure
- Cardiogenic Shock
- Mitral regurgitation
Late complications of ACS
Chronic HF
Dressler syndrome
name 4 medications that should be included on the inpatient prescription within fe w days after successful thrombolysis after Ischemic heart
Ace inhibitor
Clopidogrel
Aspirin
Beta blocker
Which other sx can people amity angina present with, ‘silent MI’ symptoms
Syncope
Dyspnoea
Confusion
List 5 conditions that mimic STEMI on their ECG findings
LBBB
Brugada syndrome
Ventricular Aneurysm
Benign early Repolarization
Pericarditis
(Look at their ECGs)
Management of NSTEMI
Asprin
Beta blockers
Clexane (anticoagulant)
Nitroglycerin/ Isordil
Morphine
