Professional Documents
Culture Documents
SYNDROME AND
ARRHYTHMIAS
STEMI
Patients with acute chest pain and persistent (>20 min) ST-segment
elevation.
NSTEMI
Any Typical
Symptoms
(chest pain
present)
74.2
66.9
7.9
5.3
Women
49.0%
38.0%
% diagnosed with MI on
admission
22.2%
50.3%
Diabetes
32.6%
25.4%
% receiving reperfusion
treatment
25.3%
74.0%
Prior heart
failure
26.4%
12.3%
In-hospital mortality
23.3%
9.3%
Older
patients
(mean age,
years)
Atypical Typical
UA
Definition
NSTEMI
Ischemia without
necrosis
Negative Biomarkers
Necrosis
(nontransmural)
Positive biomarkers
STEMI
Transmural necrosis
Positive biomarkers
Diagnosis
No ECG ST-segment elevation
Treatment
SPECTRUM OF ACS
ECG ST-segment
elevation
Immediate reperfusion
Fibrinolytics
Unfractionated heparin
Beta blockade
Spironolactone or Epleronone
Statins
FIVE DRUGS
Beta blockers
Antiplatelet agents
Statins
Nitrates
Antihypertensive and other risk factor medications
MEDICAL TREATMENT
BED REST
NITRATES
BETA BLOCKERS
NITRATES(GTN)
C/I
HYPOTENSION
USE OF SILDENAFIL WITHIN PREVIOUS 24 HR
ISOSORBIDE MONONITRATE
HIGH BIOAVAILABILITY .t1/2 4-6hrs
OTHER PREPARATIONS
NITROGLYCERINE OINTMENT
SR TRANSDERMAL PATCHES
ANTITHROMBOTIC THERAPY
HEPARIN
GP IIB/IIIA INHIBITOR
CONTROL OF PAIN
S/L NITROGLYCERINE
MORPHINE 2-4 mg IV
S/E :Venous pooling, hypotension
Diaphoresis and nausea
Bradycardia ,heart block
BETABLOCKERS
HR >60
SYSTOLIC BP>100
PR INTERVAL <0.24
RALES NOT HIGHER THAN 10 CM FROM
DIAPHRAGM
AGENTS USED
Non selective streptokinase and urokinase
Specific agents alteplase ,reteplase , tenecteplase
THROMBOLYSIS
THANK YOU