Define “acute coronary syndrome” according to the American Heart Association
Acute coronary syndrome (ACS) is defined by EITHER acute myocardial infarction or unstable angina. These patients are divided into 3 subsets: ST elevation myocardial infarction (STEMI) non-ST elevation MI Unstable angina
Describe the initial stabilizing treatment for symptomatic ischemic heart disease presenting in the ER
ECG within 10 minutes Supplemental O2 IV access continuous ECG monitoring Sublingual NTG if SBP > 90 mmHG Morphine ASA (chewed) Labs If ST elevation > 1mV or LBBB then reperfusion (fibrinolysis or PTCA)
Limited activity 12 hrs and monitor 24 hrs No prophylactic antiarrythmics IV heparin if: –large anterior MI, –PTCA, LV thrombus or –thrombolytics administered SQ heparin for all others ASA indefinitely IV NTG x 24 hrs IV beta-blocker if stable ACE inhibitor if BP permits Statin therapy
What is a coronary angiogram and why do we do we perform them?
Why are patients referred for CABG instead of undergoing a PCI approach to coronary artery disease? I.e. which patients benefit from CABG? Acute coronary Syndrome: On-going myocardial ischemia despite initial Rx ThrombolyticsRevascularization PCICABG
Cite 2 prospective randomized trials comparing PCI vs CABG for the treatment of multivessel CAD
Conclusions-SoS Trial Again, repeat revascularization remains more common after PCI (with or without a stent) in multivessel CAD. In this study, higher rate of all cause mortality with PCI
Contrast the difference between “off-pump” CABG versus the typical cardiopulmonary bypass supported CABG.
Traditional CABG General anesthetic Median sternotomy Conduit harvest (LITA, radial, vein) Institution of cardiopulmonary bypass (CPB) Cardiac arrest Placement of aortocoronary grafts Separation from CPB Close
What four medications prevent MI and death following a myocardial infarction?
Class I ASA Beta-blockers ACE inhibitor Statins
A prospective randomized trial comparing stenting with off-pump coronary surgery for high-grade stenosis in the proximal left anterior descending coronary artery: three-year follow-up JACC, 2002, 40:(11) 1955-1960