Karimi ACD

a partial thickness (subendocardial) infarct caused by the occlusion of a coronary artery, resulting a partial necrosis of the left ventricular wall (⅓ to ½ of left ventricular wall)

Nstemi

a full thickness (transmural) infarct caused by complete occlusion of blood vessel lumen, resulting in necrosis completely through the left ventricular wall

stemi

Normal tropons. ECG may be normal, show inverted T waves, or ST depression

Unstable Angina

Elevated troponins, ECG is similar to UA (normal, inverted T waves, ST depression)

Nstemi

elevated troponins. ECG shows hyperacute T waves or ST elevation (not cardiac troponins peak about 36 hours after infarct)

Stemi

the plaque ruptures and a thrombus forms, causing partial occlusion. This is a "supply ischemia” without true infarct

UA

the ruptured plaque thrombus causes a partial occlusion that is severe enough to result in injury and subendocardial infarct

Nstemi

complete occlusion of the blood vessels lumen result in a transmural infarct and injury to myocardium 

Stemi

irreversibly inhibits COX-1, which decreases thromboxane A2 (TXA2) and prevents platelet aggregation

Aspirin

Avoid normal ____ dose in children due to link to Reye’s syndrome 

aspirin

inhibit the ADP receptor to decrease platelet aggregation 

P2Y12 inhibitors

• Both prodrug and irreversible inhibitor of P2Y12 and thereby inhibits ADP-mediated platelet aggregation

• Slow offset of actions (return to baseline after 5 days)

• DI: proton pump inhibitor may reduce its effectiveness due to inhibition of CYP2C19 

• ADE: increase risk of bleeding 

Clopidogrel (Plavix)

• Produrg but activated by hydrolysis in liver

• Activation not as variable as clopidogrel, and activated mor efficiently then clop., having a faster onset of action

• ADE: Bleeding, more than Clopidogrel

• CI: pt with hx of stroke due to bleeding risk 

Prasugrel

• More rapid onset and offset than clopidogrel

• Also causes greater and more predictable inhibition of platelet aggregation

• Metabolized in liver via CYP 3A4 and thus has interactions with potent 3A4 inhibitors or inducers 

• ADE: Bleeding, dyspnea reported in 17% of patients

Ticagrelor

• Stronger platelet inhibition than aspirin

• only iv inhibitor of P2Y12

• ADE: Bleeding 

Cangrelor

IV biologic agents that inhibits Gllb/llla receptors to decrease  aggregation 

• ADE: bleeding 

  • Less common: thrombocytopenia 

Gllb/llla inhibitors

Inhibit the coagulation cascade by activating antithrombin III, which inhibits factor Xa, ultimately decreasing fibrin formation and clot formation 

• ADE: Bleeding (common), Thrombocytopenia (less common)

anticoagulants (heparin, UFH, enoxaparin)

Enzymes that mimic native native tissue plasminogen activator. They increase the formation of plasmin, which directly degrades fibrin and fibrinogen to restore blood flow

Fibrinolytics

all patients with UA, STEMI or NSTEMI should be discharged on an ______(____), unless contraindicated or patients > 75 years receive a moderate-intensity statine (due to AE)

intensive statin (atorvastatin 40-80 mg/day)

treatment with an ____ is recommended in all patients with MI, if intolerable use ___

Ace, Arb

short-acting (sublingual tablets or spray) or long-acting if vasospasms 

Nitroglycerin

reduce oxygen demand (by lowering heart rate, contractility, and blood pressure), which helps relieve anxiety and reduce pain. Less oxygen demand means less anaerobic oxidation, reducing lactic acid formation

BB