1
Q
STEMI S/SX
A
- chest pain/discomfort, SOB, N/V, weakness
- ECG : ST elevation
- Elevated troponin (cardiac enzymes +)
2
Q
STEMI goals of care
A
Reperfusion therapy
- PCI within 90 min of medical contact
or CABG
- if not 90 min, fibrinolytics should be administered within 30 min of presentation
3
Q
STEMI stabilization
A
MONAS
4
Q
PCI interventions
A
- Stent placement–> ASA for life + P2Y12 antagonist
- Thromboectomy : Thrombus aspiration (take out clot), then stent placement
- Percutaneous transluminal coronary angioplasty (PTCA): “plain old balloon angioplasty”- balloon expansion and at least temporary displacement of occlusion at site of lesion
5
Q
ASA + P2Y12 agtagonist dosing
A
1. ASA 81 mg PO \+ 2. Clopidogrel 75 mg QD - LD: 300-600 mg -DDI: PPI - lower risk of bleeding
3, Prasugrel 5-10 mg QD
- LD: 60 mg
- CI: stroke
- risk: 75+ yrs old
- Ticagrelor 90 mg BID
- LD: 180 mg
6
Q
STEMI discharge meds
A
- ASA
- P2Y12 inhibitor
- Statin
- BB
- If EF <40%, ACEI/ARB AND aldosterone antagonist (spironolactone)
7
Q
P2Y12 receptor blocker MOA
A
Inhibits binding of ADP to P2Y12 platelet receptor and decreases platelet aggregation
Clop & prasu: irreversible inhibition
Tica: reversible inhibition
