Complications of ACS
Cardiogenic shock ,occurring in approximately 10% of hospitalized MI patients mortality 60%.
left ventricular free wall rupture.
Ventricular and atrialtachyarrhythmias , bradycardia, heart block
Stroke secondary to left ventricular thrombus embolization ,
Restoration of blood flow Alleviate symptoms Relief of ischemic chest discomfort.
Sitting position is preferred
0.3 to 0.4 mg NG
Or ISDN sublingually
Wait 5‘ then take 2nd dose or 3rd dose or proceed
Wait another 15’ for a total of 30’
Spit or swallow tab
Give thanks to Allah
No continue praying &
A.E., a 65-year-old man, has been treated for chronic angina pectoris for 4 years.
He refuses cardiac catheterization and revascularization; however, his coronary risk factors include a strong family history of cardiovascular disease and hyperlipoproteinemia.
He experienced rheumatic fever at age 12; 5 years ago, his mitral valve was replaced. At that time, he had two-vessel CAD with 80% and 85% occlusion and an LV EF of 30% (normal, 55%).
Current medications include a prescription for:
warfarin 5 mg for 5 days/week and 2.5 mg for 2 days/week;
metoprolol 50 mg every day;
enalapril 10 mg every day;
digoxin 0.125 mg/day (serum digoxin concentration drawn 18 hours after the last dose is 0.7 ng/mL);
oral simvastatin 40 mg every day;
and furosemide 40 mg/day.
At his regular follow-up visit with his cardiologist, A.E. reports an increase in weekly anginal attacks over the last 2 months during his daily routine of working in his yard.
Current vital signs include
a blood pressure of 110/60 mmHg and
a resting heart rate of 60 beats/minute.
What therapeutic options would be available for A.E. for additional control of his chronic stable angina?
A.E. is at goal heart rate and his blood pressure is well controlled on his current regimen, but he continues to have anginal symptoms.
A –veinotrope CCB should not be given because A.E. has evidence of poorly controlled heart failure (EF of 30%).
A long-acting nitrate is an option, but this could lower his blood pressure more than is desired.
A dihydrpyridine (amlodipine &felodipine) may also lower blood pressure of A.E.
Because of the lack of hemodynamic effects, ranolazine is a reasonable option for A.E., in addition to continuing metoprolol.
We are the clinical pharmacy folk
So, physicians you ‘d better stop talk
When it is a drug issue
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