The balloon is inflated, squeezing open the fatty plaque deposit located on the inner lining of the coronary artery.Congestive heart failure (CHF) can be due to systolic dysfunction or diastolic dysfunction in the setting of myocardial infarction.
By Kristen J. Overbaugh, MSN, RN, APRN-BC ACUTE CORONARYHowever, a 2014 report by Montalescot et al indicates that if angiography is to be performed in a patient with NSTEMI within 48 hours of admission, treatment with the P2Y 12 antagonist prasugrel should be postponed until a decision about revascularization has been reached owing to an increased bleeding risk without ischemia benefit from pre-PCI prasugrel therapy.Doctor answers on Symptoms, Diagnosis, Treatment, and More: Dr.Administration of eptifibatide to acute coronary syndrome patients receiving enoxaparin or unfractionated heparin: effect on platelet function and thrombus formation.Current guidelines for patients with moderate- or high-risk ACS recommend an early invasive approach with concomitant antithrombotic therapy, including aspirin, clopidogrel, and unfractionated or LMWH.The study concluded that abciximab and unfractionated heparin, compared with bivalirudin, failed to reduce death, large recurrent myocardial infarction, urgent target-vessel revascularization, or major bleeding within 30 days.A meta-analysis of 34 studies analyzed the safety of CABG among patients with ACS continuing clopidogrel.
Hubbard BL, Newton CR, Carter PM, Fowler JJ, Schaldenbrand J, Singal B, et al.Prasugrel is indicated for the reduction of thrombotic cardiovascular events (including stent thrombosis) with ACS that is managed with PCI.In September 2015, the indication for ticagrelor was expanded to include use in patients with a history of MI more than 1 year previously.Acute coronary syndrome infographic Click here to see an infographic, showing how to distinguish between types of ACS, as well as treatment and management of patients.Bonaca MP, Bhatt DL, Cohen M, et al, for the PEGASUS-TIMI 54 Steering Committee and Investigators.
In the setting of PCI, consider stent thrombosis as a possible cause.Evaluation of patients who present to the hospital with acute undifferentiated chest pain or other symptoms and signs suggestive of Acute Coronary Syndrome.
Clinical Reasoning Case Study Acute Coronary Syndrome
Clopidogrel requires metabolic activation by cytochrome P450 2C19 (CYP2C19).
2015 ESC Guidelines for the management of acute coronaryLev et al found that the combination of eptifibatide with enoxaparin appears to have a more potent antithrombotic effect than that of eptifibatide and unfractionated heparin.In this procedure, a catheter is guided through an artery in the arm or leg and into the coronary arteries, then injected with a liquid dye through the catheter.Prehospital troponin T testing in the diagnosis and triage of patients with suspected acute myocardial infarction.LeLeiko RM, Vaccari CS, Sola S, Merchant N, Nagamia SH, Thoenes M, et al.Macrae AR, Kavsak PA, Lustig V, Bhargava R, Vandersluis R, Palomaki GE, et al.In the CURE trial, thienopyridine reduced the rate of myocardial infarction by 20%.
The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes: a meta-analysis.In May 2014, the FDA approved vorapaxar (Zontivity) to reduce the risk of MI, stroke, cardiovascular death, and need for revascularization procedures in patients with a previous MI or peripheral artery disease (PAD).Cardiac troponin T levels for risk stratification in acute myocardial ischemia.Briefly, this procedure involves undergoing cardiac catheterization.Fatal and life-threatening bleeding rates were not increased.Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis.Kavsak PA, MacRae AR, Newman AM, Lustig V, Palomaki GE, Ko DT, et al.Management of acute coronary syndrome is targeted against the effects of reduced blood flow to the afflicted area of the heart muscle, usually because of a blood clot.
Alogliptin after Acute Coronary Syndrome in Patients with Type 2 Diabetes. William B. White, M.D., Christopher P. Cannon, M.D., Simon R. Heller, M.D.Among patients with ACS, no differences in mortality or postoperative myocardial infarction or stroke rates were found.
Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al.Steg PG, Harrington RA, Emanuelsson H, Katus HA, Mahaffey KW, Meier B, et al.Prehospital electrocardiographic (ECG) diagnosis and direct referral for primary PCI enables patients with STEMI living far from a PCI center to achieve a system delay comparable to patients who are closer to a PCI center.The most frequently used regimen is IV metoprolol 2-5 mg given every 5 minutes (up to 15 mg total) followed by 25-100 mg given orally twice a day.Levey on nursing diagnosis for acute coronary syndrome: less.Signs or symptoms of heart failure, or new or worsening mitral regurgitation.Cardiac event rates in the platelet receptor inhibition for ischemic syndrome (PRISM) study based on troponin I results.
Another factor Xda inhibitor, fondaparinux (Arixtra), has been studied for use in patients with STEMI who do not undergo PCI.