0071643192.pdf

CARDIOVASCULAR EMERGENCIES

TABLE 2.8. Agents Used in the Treatment of Acute Coronary Syndrome

AGENT EFFECT/BENEFITS CONTRAINDICATIONS

O 2 Uncertain None

Aspirin Antiplatelet agent Allergy

Onset=minutes

Reduces long-term mortality

Clopidogrel Antiplatelet agent Expected CABG within 5 d

Ticlodipine Patient with aspirin allergy

Onset=hours

Nitroglycerin Dilates coronary arteries SBP <100 mmHg

Relaxes vascular smooth muscle RV infarct

↓Preload and afterload Use of erectile dysfunction meds

↓MyocardialO 2 demand Severe AS

May↓infarct size and ↓mortality

β-Blockers ↓Sympathetic stimulation SBP <100 mmHg

↓MyocardialO 2 demand HR <60 bpm

↓VFib Pulmonary edema

↓Long-term mortality 2nd-, 3rd-degree heart block

Reactive airway disease

Morphine ↓Sympathetic activity SBP <100 mmHg

↓Preload

↓MyocardialO 2 demand

No proven ↓in mortality

Heparin Antithrombotic agent

Synergistic effect with ASA

LMW preferred in unstable

angina or NSTEMI

Glycoprotein Blocks platelet aggregation Active internal bleeding

IIb/IIIa Benefit in patients undergoing PCI Bleeding <30 d

inhibitors Platelet count <150,000

History of intracranial hemorrhage,

AVM, aneurysm

Stroke<30 d

Major surgery or trauma < 30 d

Thrombolytics Used in STEMI <12 h from onset See Table 2.7.

Bind plasminogen, which

degrades fibrin

“Clot busting”

Primary coronary Preferred over lytics in STEMI if: PCI not available

intervention Door to cath <90 minutes

>3 h since onset

Uncertain diagnosis

ACE inhibitors LV remodeling Pregnancy

↓CHF, sudden death and History of angioedema

subsequent MI SBP <100 mmHg

↓Mortality if EF <40% Renal failure

Hyperkalemia