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  #1  
Old 01-30-2013
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Default Managing ACS

I had so much difficult getting these stuff right but after watching a lecture at one of the fine universities in America, these are what I have learned from the lecturer. Enjoy

You suspect AMI:

Everyone gets these:
1. Hx and physical exams
2. Vitals
3 12-lead EKG
4. MONA-Morphene, Oxygen(if O2Sat is low), Nitrates, Aspirin
5. B-blockers
6. Statins
----------------------------------------
Now you look at the EKG for ST changes:

Two possibilities:
1. ST Elevation which we can call an STE-MI
2. Non ST Elevation aka: ST-depression. There are two types here; Unstable Angina and Non-ST Elevation- MI.

Please note that these are continuum even whereby the patient can start with Unstable Angina-->NSTEMI-->STEMI


so let's say the patient has STEMI: you figure out if there is PCI available within 90 Minutes, if yes then PCI the patient, if no then thrombolytics(tPA) are given.


Let's say the patient has NSTEMI/UA, what would you do? you do risk assessment based on GRACE Score.

Low Risk: Conservative Strategy and you ONLY cardiac cath the patient if he/she is having recurrent symptoms or predischarge stress test showed a positive result.

High Risk: Invasive strategy thus you Cath the patient.

If you disagree with these approaches please add your comments. Thanks
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  #2  
Old 01-30-2013
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What did you mean by Conservative Strategy in patient with NSTEMI/UA?
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  #3  
Old 02-01-2013
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STEMI: Aspirin(or Clopidogrel)-----> Angioplasty(90 mins/no Cath)


NSTEMI/UA: Aspirin--->Heparin
(this is approach is when GRACE score is low). This is the conservative strategy.

However we MUST CATH NSTEMI/UA in these situations:

1. If there is recurrent angina
2. Stress test before discharge is positive. Remember everyone MUST undergo Stress test before discharge from the Hospital
3. If the GRACE score is high
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