Ischemic Heart Disease 2
Terms
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- Ischemia Definition
- Lack of oxygen from inadequate perfusion due to an imbalance between oxygen supply and demand
- Ischemic heart disease definition
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Cause most frequently by atherosclerosis
May present as silent, chest pain or MI - Angina definition
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Discomfort or pain in chest, arm shoulder, back or jaw
Worsened by exertion - relieved by SL NTG - Acute Coronary Syndrome
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Unstable Angina
Non ST-segment MI (NSTEMI)
ST-segment MI (STEMI) - Angina Immediate Treatment
- Short-acting nitrates
- Angina Prevention
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Beta blockers
Calcium channel blockers
long-acting nitrates - Angina Antiplatelet
- Aspirin or clopidogrel
- Unstable Angina/NSTEMI treatment
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MONA
Morphine
Oxygen
Nitroglycerin
Aspirin - Unstable Angina/NSTEMI Anti-ischemic therapy
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Beta blocker
Nitrates
CCB - 2nd line
ACEI - 2nd line - Unstable Angina/NSTEMI Antiplatelet therapy
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Aspirin
Ticlopidine - Unstable Angina/NSTEMI Anticoagulant therapy
- Heparin or LMWH with ASA or clopidogrel
- STEMI management
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MONA
Morphine
Oxygen
Nitrates
Aspirin - Nitrate use in STEMI
- Use in first 24 hours if no hypotension, bradycardia or tachycardia
- Beta Blockade in STEMI
- Early use increases chance of survival
- Heparin use in STEMI
- Use heparin or LMWH with fibrinolytic
- Heparin Mechanism of actions
- Enhances action of antithromin III - prevents fibrinogen to fibrin
- Heparin Monitoring
- aPTT, PT, platelet count, hgb/hct, bleeding
- Heparin reversal med
- Protamine
- LMWH mechanism
- inhibits thrombin (factor Xa)
- LMWH monitoring
- platelets - not aPTT or PT