Acute Coronary Syndrome (Assessment and Plan): Difference between revisions
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Author: [[User:William J Gibson|William J Gibson MD, PhD]] | Author: [[User:William J Gibson|William J Gibson MD, PhD]] | ||
Patient presents with XX hour history of [substernal] chest pain that radiates to [jaw/arm], associated with [diaphoresis, shortness of breath]. EKG on admission showing XX. Troponin on admission XX and subsequently trended to XX XX hours later. [Most likely type 1 MI given abrupt onset, ST-segment elevation OR History suggests type 1 MI given high concern for supply demand mismatch. Differential includes coronary dynamic/non-occlusive obstruction (including vasospasm, microvascular ischemia, Takutsubo cardiomyopathy), non-plaque associated thromboembolism () | Patient presents with XX hour history of [substernal] chest pain that radiates to [jaw/arm], associated with [diaphoresis, shortness of breath]. EKG on admission showing XX. Troponin on admission XX and subsequently trended to XX XX hours later. [Most likely type 1 MI given abrupt onset, ST-segment elevation OR History suggests type 1 MI given high concern for supply demand mismatch. Differential includes coronary dynamic/non-occlusive obstruction (including vasospasm, microvascular ischemia, Takutsubo cardiomyopathy), non-plaque associated thromboembolism (Afib, cardioversion, PFO), coronary dissection, vascular steal, vasculitis. | ||
Dx: | |||
- Serial EKG (Q30 mins initially), if STEMI | |||
- Serial troponins (admission, 2H and 6H) if concern ACS rapidly evolving, 3x Q6H for rule-out | |||
Tx: | |||
- Treat any secondary causes of myocardial ischemia (eg AF w RVR, anemia, hypoxemia (only if O2sat <92%), infection) | |||
Initial therapy: | |||
- Anticoagulation/Anti-platelet: ASA (325), Heparin drip (goal PTTT 60-80), | |||
- Pain: sublingual nitro PRN, | |||
Post-stenting: | |||
- if stented will give clopidogrel 75mg PO QD (30 days of BMS, 1 year for DES)<blockquote></blockquote> | |||
Revision as of 00:50, 18 November 2017
Author: William J Gibson MD, PhD
Patient presents with XX hour history of [substernal] chest pain that radiates to [jaw/arm], associated with [diaphoresis, shortness of breath]. EKG on admission showing XX. Troponin on admission XX and subsequently trended to XX XX hours later. [Most likely type 1 MI given abrupt onset, ST-segment elevation OR History suggests type 1 MI given high concern for supply demand mismatch. Differential includes coronary dynamic/non-occlusive obstruction (including vasospasm, microvascular ischemia, Takutsubo cardiomyopathy), non-plaque associated thromboembolism (Afib, cardioversion, PFO), coronary dissection, vascular steal, vasculitis.
Dx:
- Serial EKG (Q30 mins initially), if STEMI
- Serial troponins (admission, 2H and 6H) if concern ACS rapidly evolving, 3x Q6H for rule-out
Tx:
- Treat any secondary causes of myocardial ischemia (eg AF w RVR, anemia, hypoxemia (only if O2sat <92%), infection)
Initial therapy:
- Anticoagulation/Anti-platelet: ASA (325), Heparin drip (goal PTTT 60-80),
- Pain: sublingual nitro PRN,
Post-stenting:
- if stented will give clopidogrel 75mg PO QD (30 days of BMS, 1 year for DES)