ACS Q+A

What following tests can be used to diagnose an MI?

ECG

Troponin

CK-MB

________ should not be used in patients with STEMI precipitated by cocaine use because of the risk of exacerbating coronary spasm.

beta-blockers

ACS initial measures

MONA

Morphine: only PRN severe pain

Oxygen: only when O2 sat < 90% Nitrates: SL NTG up to 3 times Q 5 min, may do IV after

Aspirin: plus possibly another antiplatelet (DAPT) if ASA allergy, use clopidogrel or ticagrelor

BB: metoprolol 25 mg oral if not hypertensive, IV if hypertensive (5 mg IV Q 5 min x 3)

high intensity statin: lipitor 40-80 mg or Crestor 20-40 mg

Serial ECGs

Serial troponins (hs cardiac troponins ar preferred)

Why are beta-blockers used in AMI (acute myocardial infarction)?

• decrease heart rate, ventricular contractility, and afterload → less workload and less oxygen demand

• BB can reduce infarct size, and reduce the incidence of arrhythmias, ventricular ectopy, and fibrillation

• BB can decrease rate of re-infarction and mortality

• typically BBs used in ACS are metoprolol or atenolol

What medication should an MI patient be discharged on?

NAABAS

• Ntg

• Aspirin

• another antiplatelet if stened (DAPT)

• beta-blocker

• ACEI

• high statin

Fibrinolytic therapy in STEMI patient

patients with symptoms onset within 12 hours who cannot have PCI should receive fibrinolytic therapy

the time interval from hospital arrival to initiation of fibrinolytic drug should be less than 30 mins

patients receiving fibrinolytic therapy benefit from pretreatment with clopidogrel but not a glycoprotein (GP) IIb/IIIa inhibitor.