STEMI VS Non STEMI COMPARISON IN ADMITTED MANAGEMENT. 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction
STEMI VS Non STEMICOMPARISON IN ADMITTED MANAGEMENT
2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction
ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction
Management of acute coronary syndromes: an
Update, Heart 2004;90;698-706
nitroglycerin (0.4 mg) every 5 minutes for a total of
3 doses →consider iv nitroglycerin
a.) relief of ongoing ischemic discomfort
b.) control of hypertension
c.) management of pulmonary congestion
HR<50 or >100
suspected RV infarction
phosphodiesterase inhibitor for erectile dysfunction in
the past 24 hrs
to those patients without a contraindication
without contraindications ,especially if a
tachyarrhythmia or hypertension is present.
not beyond 24 hrs
abciximab versus 4.8% (88/1823) without
Non ST-elevation MI
early invasive strategy
presentation and continued indefinitely.
patients who are unable to take ASA
should be added to ASA as soon as possible on
admission and administered for at least 1 month and for
up to 9 months.
in addition to ASA and heparin, to patients in whom
catheterization and PCI are planned. The GP IIb/IIIa
antagonist may also be administered just prior to PCI.
high risk for bleeding, clopidogrel should be started and
continued for at least 1 month and for up to 9 months.
CABG is planned, the drug should be withheld for
5 to 7 days
addition to ASA and LMWH or UFH, to patients
with continuing ischemia, an elevated troponin, or
with other high-risk features in whom an invasive
management strategy is not planned.
administered to patients already receiving
heparin, ASA, and clopidogrel in whom
catheterization and PCI are planned. The GP
IIb/IIIa antagonist may also be administered
just prior to PCI.
LMWH or UFH, to patients without continuing
ischemia who have no other high-risk features
and in whom PCI is not planned.
patients without acute ST-segment
elevation, a true posterior MI, or a
presumed new left bundle-branch block.
whom PCI is not planned.
NSTEMI without serious comorbidity and who
have any of the following high-risk indicators:
activities despite intensive anti-ischemictherapy.
S3 gallop, pulmonary edema, worsening rales, or new
or worsening MR
early conservative or an early invasive strategy
may be offered in hospitalized patients without
contraindications for revascularization.
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