Best markers for mi troponin i and troponin t o most

 Best markers for MI: Troponin I and Troponin T
o Most sensitive and specific
o Detectable 2-12 hours, up to 5-14 days
o Obtain at presentation and q3-6h
 NSTEMI: medications or PCI (stent)
 STEMI: give fibrinolytic if not able to receive PCI within 2 hours
 Treatment: MONA-GAP-BA (+ PCI or fibrinolytic if STEMI)
o Morphine IV
o O2
o Nitrates
o ASA (325mg)
o Gp2b3a
o Anticoagulant (heparin)
o P2Y12 (Plavix, Brillinta, Effient)
 Avoid if CABG
 Prasugrel only if PCI
o Beta blocker (within 24 hours)
o ACE (within 24 hours)
o No NSAIDs while hospitalized, no Nifedipine
 Plavix and Effient (Prasugrel): Thienopyridines
o Irreversibly bind
 Brillinta (Ticagrelor) is not a prodrug like the above, and is reversible
o Keep in original container
o 90mg PO BID x1 year, then 60mg PO BID
o If also using ASA, stay at 81mg
 GP2b3a Inhibitors
o Abciximab (Reopro)
 Avoid if NSTEMI without PCI
 Must filter
o Eptifibatide (Integrilin)
o Tirofiban (Aggrastat)
 Fibrinolytics
o Only used for STEMI
o 90 minutes door to balloon
o 120 minutes within medical contact
o Give within 30 minutes if 2 hour PCI impossible
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o Alteplase
 >67kg: 100mg IV
 < 67kg: boluses
o Tenecteplase
 Protease Inhibitor, Receptor 1
o Voraxapar
 Essentially irreversible
 Acts on platelets
 Still in clinical trials
 ACS secondary prevention
o ASA 81mg indefinitely
o DAPT x12 months (Plavix or Brillinta)
o If PCI, DAPT x 12 months (Plavix, Effient, Brillinta)
o NTG indefinitely
o BB x 3 years
o ACE indefinitely
o Statin
 Naproxen is safest NSAID for cardiac patients
 Triple antithrombotic therapy
o Warfarin + ASA + Plavix
 Goal INR 2-2.5
 Always give PPI if history of GI bleed
CHF
 Separate ACE and Entresto by 36 hours
 EF <40%  systolic dysfunction (HFrEF)
  BNP, proBNP  HF exacerbation
 Stages
o A: asymptomatic, at risk
o B: asymptomatic, heart disease present
o C: symptoms at exertion
o D: symptoms at rest
 Classes
o I: no limitations
o II: slight limitations
o III: minimal exertion causes symptoms
o IV: symptoms at rest
 Remodeling:  CO causes  force of contractions. Over time, this causes changes to the heart
 3 Neurohormonal Pathways:
o RAAS
o Sympathetic Nervous System
o Vasopression (vasoconstriction, H20 retention)
 Daily weight (  2-4 lbs/day or 5 lbs/week)
 Sodium < 1500mg/day
 Hawthron/CoQ10 options
 Loop Diuretics  all of these are 1:1 IV:PO
o Lasix (max 600mg)
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o Bumex (max 10mg)
o Torsemide (max 200mg)
o Ethacrynic Acid (max 400mg)
 Lasix 40mg = Bumex 1mg = Torsemide 20mg = EA 50mg
 ACE/ARBs for HF
o Captopril
o Enalapril
o Fosinopril
o Lisinopril
o Quinapril
o Ramipril
o Losartan
o Valsartan
o Candesartan
o Entresto
 Beta Blockers
o Avoid ones with intrinsic sympathomimetic activity
o Best: Bisoprolol, Metoprolol Succinate, Coreg
 Metoprolol 1mg IV = 2.5mg PO
 Aldosterone Antagonists
o Spironolactone and eplerenone
o Used for NYHA Class II-IV
 Hydralazine: arterial vasodilator,  afterload
 Nitrates: venous vasodilation,  preload
