Slide for Acute coronary syndrome (STEMI ACC 2013 & NSTEMI ESC 2011) Ramathibodi Hospital, Mahidol University Wisuit Katekao, MD - June 2014

1. Acute Coronary Syndrome
Wisuit Katekao, MD
Thursday, June 26, 14

2. ACS
• ST-segment elevation MI
• Non ST-segment elevation MI
• Unstable Angina
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4. Normal EKG
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6. ACC 2013 Definition
• New-LBBB
• New-STE for 2 contiguous leads
• > 2 mm in men , 1.5 mm in women (V2-V3)
• > 1 mm in other chest leads & limb leads
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10. New-LBBB
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15. Primary PCI
• 1st - ASA ให้แน่นอน 162-325 mg
• 2nd - เลือกเอาระหว่าง 3 ตัวดังนี้ load ASAP
• Clopidogrel 600mg
• Prasugrel 60mg
• Ticagrelor 180mg
Thursday, June 26, 14

16. Primary PCI
• Heparin - ให้ bolus ระหว่าง cath
• ถ้ามี IIb/IIIa = ให้ UFH 50-70 u/kg IV
• ถ้าไม่ได้ = ให้ UFH 70-100 u/kg IV
• No role for ENOXA & Fonda !!!
Thursday, June 26, 14

17. Fibrinolytic
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20. Thrombolytics
• 1st - ASA ให้แน่นอน 162-325 mg
• 2nd - ให้ได้แค่ Clopidogrel เท่านั้น
• อายุน้อย < 75 --- 300mg load
• แก่ > 75 --- ให้แค่ 75mg ก็พอ เพราะกลัว
bleed !!!
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27. ST depression
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29. STE aVR & V1
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33. Digoxin Intox
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