Best markers for MI Troponin I and Troponin T o Most sensitive and specific o

Best markers for mi troponin i and troponin t o most

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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 14
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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) 15
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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
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  • Fall '08
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  • generation antipsychotics, Alpha Reductase Inhibitors, GI side effects, A. fib

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