ACS canvas

ECG

diagnosis of ACS

antiplatelet drugs, anticoagulants, nitrates, beta-blockers, and, for STEMI, emergency reperfusion via fibrinolytic drugs, percutaneous intervention, or, occasionally, coronary artery bypass graft surgery

tx for acs

acute thrombus in an atherosclerotic coronary artery

most common cause of acs

stable angina

angina pain develops when there is increased demand in the setting of a stable atherosclerotic plaque

unstable angina

angina pain occurs at rest or progresses rapidly over a short period of time

NSTEMI

subendocardial infarct

unstable angina

supply ischemia, no infarc

STEMI

transmural infarct

STEMI

characterized by complete occlusion of the blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected in ECG changes and a rise in troponins

cardiac troponin

cardiac marker elevated in unstable angina

midline anterior chest discomfort (usually at rest)

predominant symptom of ACS

1. Aspirin

P2Y₁₂ receptor antagonist

1. Clopidogrel (Plavix)

2. Prasugrel (Effient)

3. Ticagrelor (Brilinta)

antiplatelet agents for acs

1. Bivalirudin (Angiomax)

2. Enoxaparin (Lovenox)

3. Fondaparinux (Arixtra)

4. Unfractionated heparin

anticoagulants for acs

Bivalirudin (angiomax)

preferred over unfractionated heparin with GP IIb/IIIa receptor antagonist if high risk of bleeding

Fondaparinux (Arixtra)

With PCI: not recommended as sole antiocoagulant

1. Carvedilo, oral (Coreg)

2. Metoprolol, IV

3. Metoprolol (Lopressor)

beta blockers for ACS

1. Captopril

2. Lisinopril

ACE inhibitors for acs

1. Valsartan (Diovan)

Angiotensin receptor blocker (ARB) for ACS

Valsartan (Diovan) - ARBs

may be used if patient cannot tolerate ACE inhibitors