Muscle streptokinase tissueplasminogenactivatortpa

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Unformatted text preview: kinase, AST = Aspartate Aminotransferase, LDH = lactate dehydrogenase STEMI STEMI Emergency Management ASA Antiplatelets­ ASA, clopidogrel = acetylsalicylic acid - aspirin Anti­ischaemics­ beta blockersReduce abnormal arrhythmias they get Fibrinolytics Lyse clots – time is muscle Streptokinase Tissue plasminogen activator­ tPa Thrombokinase­ tnk Primary Angioplasty­ coronary revascularisation Anticoagulation Angiogram Angiogram ECG with NON­STEMI ECG with NON­STEMI TIMI RISK SCORE for UA/NSTEMI HISTORICAL Age ≥ 65 POINTS 1 ≥ 3 CAD risk factors 1 Known CAD (stenosis ≥ 50%) 1 ASA use in past 7 days 1 (FHx, HTN, ↑ chol, DM, active smoker) PRESENTATION Recent (≤ 24H) severe angina 1 ↑ cardiac markers 1 1 ST deviation ≥ 0.5 mm RISK OF CARDIAC EVENTS (%) BY 14 DAYS IN TIMI 11B* RISK SCORE DEATH OR MI DEATH, MI OR URGENT REVASC 0/1 2 3 4 5 6/7 3 3 5 7 12 19 5 8 13 20 26 41 RISK SCORE = Total Points (0 - 7) *Entry criteria:UA or NSTEMII defined as ischemic pain at rest within past 24H, with evidence of CAD (ST segment deviation or +marker) For more info go to www.timi.org Antman et al JAMA 2000; 284: 835 - 842 ACS ALGORITHM in ED ACS Chest pain Suspicious for cardiac? Risk Yes *High ASA Clopidogrel Enoxaparin Tirofiban EARLY CATH (<24h) No Low OPT f/u ASA Clopidogrel +/- Enoxaparin Fxn test If +, CATH * = TIMI risk...
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