In Cardiology, one of the most feared diagnosis is a STEMI. Here are my thoughts as a cardiology fellow!
Part 3: Medical Management
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Part 3: Medical Management
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#MedTwitter #MedEd #CardioTwitter #IMG
Aspirin Therapy:
- Should be given immediately upon presentation
- Dose should be 4-81 mg chewable tablets (rapid absorption) or 324 mg
- Can consider rectal administration if NPO
- Clopidogrel monotherapy is best alternative
- Should be given immediately upon presentation
- Dose should be 4-81 mg chewable tablets (rapid absorption) or 324 mg
- Can consider rectal administration if NPO
- Clopidogrel monotherapy is best alternative
Nitroglycerin:
- Can be useful in the management of acute MI complicated by heart failure, persistent chest pain, or hypertension
- Should not be given to patients that are hypotensive, suspicion for RV infarction, or recent use of PDE inhibitors (24-48 hours)
- Can be useful in the management of acute MI complicated by heart failure, persistent chest pain, or hypertension
- Should not be given to patients that are hypotensive, suspicion for RV infarction, or recent use of PDE inhibitors (24-48 hours)
Oral P2Y12 Receptor Antagonists:
- 3 agents: Clopidogrel, Prasugrel, and Ticagrelor
- Loading doses: Clopidogrel (600 mg), Prasugrel (60 mg) and Ticagrelor (180 mg)
- Maintenance Doses: Clopidogrel (75 mg), Prasugrel (10 mg) and Ticagrelor (90 mg BID)
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- 3 agents: Clopidogrel, Prasugrel, and Ticagrelor
- Loading doses: Clopidogrel (600 mg), Prasugrel (60 mg) and Ticagrelor (180 mg)
- Maintenance Doses: Clopidogrel (75 mg), Prasugrel (10 mg) and Ticagrelor (90 mg BID)
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Oral P2Y12 Receptor Antagonists:
- Clopidogrel & Prasugrel irreversibly inhibit the P2Y12 receptor
- Ticagrelor is reversible direct inhibitor of this receptor
- Should not use Prasugrel in patients with history of TIA /stroke (bleeding risk)
- Clopidogrel & Prasugrel irreversibly inhibit the P2Y12 receptor
- Ticagrelor is reversible direct inhibitor of this receptor
- Should not use Prasugrel in patients with history of TIA /stroke (bleeding risk)
IV P2Y12 Receptor Antagonists:
- Cangrelor: IV P2Y12 inhibitor that bind reversibly to the receptor
- Short plasma half-life (<5 minutes) allows for near complete restoration of platelet function within 1-2 hours after stopping infusion
- Good for inpatient management
- Cangrelor: IV P2Y12 inhibitor that bind reversibly to the receptor
- Short plasma half-life (<5 minutes) allows for near complete restoration of platelet function within 1-2 hours after stopping infusion
- Good for inpatient management
Parenteral Anticoagulation:
- All STEMI patients should receive IV anti-thrombotic therapy
- Typically, unfractionated heparin (with bolus and continuous infusion) to achieve a therapeutic activated clotting time
- All STEMI patients should receive IV anti-thrombotic therapy
- Typically, unfractionated heparin (with bolus and continuous infusion) to achieve a therapeutic activated clotting time
Reperfusion Therapy:
- Primary goal is reperfusion therapy as quickly as possible within 12-24 hours of symptom presentation
- Door to balloon time should be โค 90 minutes
- Transfer time to PCI-capable hospital should be โค 120 minutes (if possible)
- Primary goal is reperfusion therapy as quickly as possible within 12-24 hours of symptom presentation
- Door to balloon time should be โค 90 minutes
- Transfer time to PCI-capable hospital should be โค 120 minutes (if possible)
TPA Absolute Contraindications:
- Previous hemorrhagic stroke/ischemic stroke within 3 months
- Known intra-cranial neoplasm
- Structural cerebral vascular lesion
- Active bleeding
- Suspected aortic dissection
- Severe uncontrolled hypertension
- Previous hemorrhagic stroke/ischemic stroke within 3 months
- Known intra-cranial neoplasm
- Structural cerebral vascular lesion
- Active bleeding
- Suspected aortic dissection
- Severe uncontrolled hypertension
*Not to use for medical advice, always review with your fellow & attending*
Time is myocardium! The key is discuss with your interventional colleagues early for revascularization. Use medical management before activation of the cath lab. Let me know what you think! ๐
Time is myocardium! The key is discuss with your interventional colleagues early for revascularization. Use medical management before activation of the cath lab. Let me know what you think! ๐
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