0
D.Basem elsaid enany
Lecturer of cardiology
Ainshams university
Cautious with nitartes+sildenafil or
RV infarction
1. Thienopyridine: If the patient is undergoing same day PCI, give
clopidogrel 600 mg; for patients undergoing early PCI i...
** AIVR: incidence is about 2% ,after 72 h(10% in STEMI, first
48h)
AIVR is neither a sensitive nor very specific marker f...
Pulseless VT
SVT
-The AHA recommends that beta-blockers not be administered acutely in patients with ACS
or undifferentiated chest pain in ...
Proinflammatory and prothrombotic effects of red blood
cell transfusion have been demonstrated.
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
management of acute coronary syndrome
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management of acute coronary syndrome

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Transcript of "management of acute coronary syndrome"

  1. 1. D.Basem elsaid enany Lecturer of cardiology Ainshams university
  2. 2. Cautious with nitartes+sildenafil or RV infarction
  3. 3. 1. Thienopyridine: If the patient is undergoing same day PCI, give clopidogrel 600 mg; for patients undergoing early PCI in whom thienopyridine is withheld before PCI AND who are not at high risk of bleeding (age <75 years, weight ≥60 kilograms, no history of stroke or TIA) give prasugrel 60 mg instead of clopidogrel 2. GP IIb/IIIa inhibitor (either eptifibatide or tirofiban) may be added to or in place of clopidogrel in some circumstances (eg, high risk patient). Abciximab is contraindicated in patients not referred for cardiac catheterization.
  4. 4. ** AIVR: incidence is about 2% ,after 72 h(10% in STEMI, first 48h) AIVR is neither a sensitive nor very specific marker for successful reperfusion with no ttt as usually transient. •Sustained monomorphic VT that is hemodynamically tolerated and asymptomatic can be treated initially with intravenous amiodarone if fail after initial 150mg Synchronized electrical cardioversion •Electrolytes should be aggressively repleted (serum potassium goal >4.0 meq/L and serum magnesium goal >2.0 mg/dL) The 2010 AHA guidelines give a weak recommendation regarding the use of intravenous lidocaine for the treatment of recurrent sustained VT, stating it should only be considered for use if amiodarone is not available --(no ttt for PVCs, NSVT)
  5. 5. Pulseless VT
  6. 6. SVT
  7. 7. -The AHA recommends that beta-blockers not be administered acutely in patients with ACS or undifferentiated chest pain in the setting of cocaine useunopposed a-adrenergic effect -The administration of labetolol in the setting of cocaine use is not recommended by the AHA. Labetolol has substantially more beta-blocking than alphablocking effects. -Not well studied: short-acting nifedipine should never be used, and verapamil and diltiazem should be avoided in the setting of heart failure or decreased left ventricular systolic function. -Sinus tachycardia and atrial tachyarrhythmias may respond to benzodiazepines. In cases of atrial tachyarrhythmias that do not respond to benzodiazepines, verapamil or diltiazem can be considered. -Ventricular arrhythmias that occur immediately after cocaine use are thought to result from effects on the sodium channel and may respond to the administration of sodium bicarbonate, similar to arrhythmias associated with type IA and IC agents. Ventricular arrhythmias that occur several hours after cocaine use usually are due to ischemia. In case of persistent ventricular arrhythmias, lidocaine can be used.
  8. 8. Proinflammatory and prothrombotic effects of red blood cell transfusion have been demonstrated.
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