2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

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Dr. Juan Carlos Becerra Martinez

Health & Medicine

JACC. September 23, 2014. Accepted Manuscript

Pathophysiology
JACC. September 23, 2014. Accepted Manuscript

Presentation
JACC. September 23, 2014. Accepted Manuscript

TIMI Risk Score
JACC. September 23, 2014. Accepted Manuscript

GRACE Risk Model
JACC. September 23, 2014. Accepted Manuscript

Early Risk Stratification
JACC. September 23, 2014. Accepted Manuscript

Cardiac Biomarkers
JACC. September 23, 2014. Accepted Manuscript

Medical Management
JACC. September 23, 2014. Accepted Manuscript

Aspirin
JACC. September 23, 2014. Accepted Manuscript

P2Y12 Inhibitors
JACC. September 23, 2014. Accepted Manuscript

GP IIb/IIIa inhibitors
Abciximab: better downstream
JACC. September 23, 2014. Accepted Manuscript

Parenteral anticoagulant
JACC. September 23, 2014. Accepted Manuscript

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JACC. September 23, 2014. Accepted Manuscript

Non-anginal pain management
JACC. September 23, 2014. Accepted Manuscript

Special patient groups
JACC. September 23, 2014. Accepted Manuscript

Puntos a discutir…
1.- Ya no usar CKMB ni mioglobina en el abordaje diagnóstico
2.- BNP es útil en estratificación
3.- Mejor ticagrelor/prasugrel que clopidogrel
4.- Prasugrel solo si se colocan stents
5.- Mejor eptifibatide/tirofibán que abciximab para terapia “upstream”
6.- Bivalirudina solo en estrategia invasiva
7.- Pacientes con fondoparinux: hacer switch a otro anticoagulante en caso de
cateterismo
8.- La estrategia “conservadora inicial” ahora se llama “guiada por isquemia”

Puntos a discutir…
9.- Cuatro estrategias de tratamiento:
- Guiada por isquemia (antes conservadora)
- Invasiva Inmediata (2 hrs)
- Invasiva temprana (24 hrs)
- Invasiva tardía (25-72 hrs)
10.- Se añade la pirámide invertida de analgésicos
11.- B-bloqueadores pueden desencadenar espasmo coronario en
pacientes con uso reciente de cocaína / metaanfetaminas
12.- Nuevas recomendaciones sobre Takotsubo

This highly energetic lecture presents the pathophysiology of S-T elevation myocardial infarction in an easy to understand style to help you best identify, triage and treat patients presenting with acute coronary syndromes. Using the latest research behind the AHA Guidelines changes, AHA National Faculty Rom Duckworth will help you better coordinate with you partners along the continuum of cardiac care. Emphasis is placed on risk factors, recognizing truly sick patients and coordinating care with hospital personnel. Learning Objectives: Students will learn: -The pathophysiology of S-T elevation myocardial infarction. -The difference between STEMI, NSTEMI and unstable angina. -Differing treatment methods and priorities for different cardiac syndromes. -The function and importance of 12 lead ECG and prehospital diagnostic testing. -The roles and responsibilities of EMS providers as the key element in “door-to-balloon” and “door-to-needle” time for STEMI patients. www.romduck.com www.RescueDigest.com

Acute Coronary Syndrome - Overview

Rahul Varshney

Acute Coronary Syndrome - dr. Lucia Kris Dinarti

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DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 1 DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT DISCHARGE SUMMARY: PCI IN THE ELDERLY PATIENT 6 DISCHARGE SUMMARY: PCI in the Elderly Patient Professor: XXXX Student Name Grand Canyon University-ANP 654 Date DISCHARGE SUMMARY Discharge Summary Date XXXX-ANP 654 Patient Name: H.W. MRN: 123456 Sex: Male Date of Birth: 12/12/1933 Provider: C.H. APRN/MILLENIUM PHYSICIAN GROUP Primary Care Provider: Dr. S.B. Admission Date: xx/xx/xxxx Discharge Date: xx/xx/xxxx Admitting Diagnoses: I25.1 Atherosclerotic heart disease of native coronary artery R00.1 Bradycardia, unspecified (permanent pacemaker placed by Dr. R 12/28/2019) I10 Renovascular hypertension N18.6 End stage renal disease (on peritoneal dialysis) Discharge Diagnosis: I25.1 Atherosclerotic heart disease of native coronary artery-elective cardiac catheterization on this admission R00.1 Bradycardia, unspecified I10 Renovascular hypertension controlled I70.1 Atherosclerosis of renal artery N18.6 End stage renal disease (peritoneal dialysis 1/14/20 prior to discharge) Admission Procedure: 01/13/20- Cardiac catheterization under moderate sedation with use of IVP contrast for coronary angiography Impression: Non-dominant RCA without significant obstructive disease <60%. OM with an 80% proximal lesion, Circumflex with mid 90% lesion, LAD is without disease, large diagonals without disease. LV function is normal, EF 50%, no wall motion abnormalities. PCI to the OM and Circumflex were performed with good results. Consultations: Dr. R Interventional Cardiologist- performed elective cardiac catheterization 1/13/20 Course of Treatment: This is an 86 year-old male patient with a complex cardiac history. The patient had a permanent pacemaker placed on 12/28/2019 for severe symptomatic bradycardia. After pacemaker placement, the patient underwent a Lexiscan showing ischemia. A planned cardiac catheterization was scheduled for 1/13/20. Dr. R. performed PCI and placed BM stents to the patient’s OM and Circumflex arteries. His RCA was assessed and was deemed not severe enough for intervention and was a non-dominant vessel. The patient was admitted for further observation overnight post procedure. He had no complaints of chest pain, no shortness of breath, no nausea or vomiting, no dizziness, and no numbness or tingling in his bilateral lower extremities. No hematoma, redness or swelling noted at his right groin catheterization site. Overall, the patient is stable for discharge this evening after his peritoneal dialysis treatment. Admission Home Medications: Auryxia 210mg, 2 tabs, po three times daily Entresto 24/26mg, 1 tab, po twice daily Thiamine 100mg po daily Docusate sodium 100mg po twice daily Discharge Medication: Auryxia 210mg, 2 tabs, po three times daily Entresto 24/26mg, 1 tab, po twice daily Thiamine 100mg po daily Docusate sodium 100mg po twice daily New: Nitroglycerine 0.4mg, one tablet SL ...

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2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

1. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes DR. JUAN CARLOS BECERRA MARTÍNEZ Fellow en Cardiología Intervencionista, UMAE HE CMNO ACC Fellow in-Training Miembro ESC, EAPCI, SCAI, SOLACI, SOCIME, CCJ JACC. September 23, 2014. Accepted Manuscript

2. JACC. September 23, 2014. Accepted Manuscript

3. Pathophysiology JACC. September 23, 2014. Accepted Manuscript

4. Presentation JACC. September 23, 2014. Accepted Manuscript

5. TIMI Risk Score JACC. September 23, 2014. Accepted Manuscript

6. GRACE Risk Model JACC. September 23, 2014. Accepted Manuscript

7. Early Risk Stratification JACC. September 23, 2014. Accepted Manuscript

8. Cardiac Biomarkers JACC. September 23, 2014. Accepted Manuscript

9. Medical Management JACC. September 23, 2014. Accepted Manuscript

10. Medical Management JACC. September 23, 2014. Accepted Manuscript

11. Medical Management JACC. September 23, 2014. Accepted Manuscript

12. Medical Management JACC. September 23, 2014. Accepted Manuscript

13. Aspirin JACC. September 23, 2014. Accepted Manuscript

14. P2Y12 Inhibitors JACC. September 23, 2014. Accepted Manuscript

15. GP IIb/IIIa inhibitors Abciximab: better downstream JACC. September 23, 2014. Accepted Manuscript

16. Parenteral anticoagulant JACC. September 23, 2014. Accepted Manuscript

17. JACC. September 23, 2014. Accepted Manuscript

18. JACC. September 23, 2014. Accepted Manuscript

19. Strategies JACC. September 23, 2014. Accepted Manuscript

20. Non-anginal pain management JACC. September 23, 2014. Accepted Manuscript

21. Special patient groups JACC. September 23, 2014. Accepted Manuscript

22. Special patient groups JACC. September 23, 2014. Accepted Manuscript

23. Special patient groups JACC. September 23, 2014. Accepted Manuscript

24. Special patient groups JACC. September 23, 2014. Accepted Manuscript

25. Special patient groups JACC. September 23, 2014. Accepted Manuscript

26. Special patient groups JACC. September 23, 2014. Accepted Manuscript

27. Puntos a discutir… 1.- Ya no usar CKMB ni mioglobina en el abordaje diagnóstico 2.- BNP es útil en estratificación 3.- Mejor ticagrelor/prasugrel que clopidogrel 4.- Prasugrel solo si se colocan stents 5.- Mejor eptifibatide/tirofibán que abciximab para terapia “upstream” 6.- Bivalirudina solo en estrategia invasiva 7.- Pacientes con fondoparinux: hacer switch a otro anticoagulante en caso de cateterismo 8.- La estrategia “conservadora inicial” ahora se llama “guiada por isquemia”

28. Puntos a discutir… 9.- Cuatro estrategias de tratamiento: - Guiada por isquemia (antes conservadora) - Invasiva Inmediata (2 hrs) - Invasiva temprana (24 hrs) - Invasiva tardía (25-72 hrs) 10.- Se añade la pirámide invertida de analgésicos 11.- B-bloqueadores pueden desencadenar espasmo coronario en pacientes con uso reciente de cocaína / metaanfetaminas 12.- Nuevas recomendaciones sobre Takotsubo

29. Gracias!

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

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2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes