ST elevation myocardial infarction discharge care: Difference between revisions

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Revision as of 16:46, 25 March 2013

Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters

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Patient Information

Overview

Pathophysiology

Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology

Causes

Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors

Triggers

Natural History and Complications

Risk Stratification and Prognosis

Pregnancy

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

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Coronary Angiography

Treatment

Pre-Hospital Care

Initial Care

Oxygen
Nitrates
Analgesics
Aspirin
Beta Blockers
Antithrombins
The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Fibrinolysis
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
CABG
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Aspirin
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Overview
Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

Case #1

Case #2

Case #3

Case #4

Case #5

ST elevation myocardial infarction discharge care On the Web

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on ST elevation myocardial infarction discharge care

CDC on ST elevation myocardial infarction discharge care

ST elevation myocardial infarction discharge care in the news

Blogs on ST elevation myocardial infarction discharge care

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for ST elevation myocardial infarction discharge care

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)[1]

PCI of a Noninfarct Artery Before Hospital Discharge (DO NOT EDIT)[1]

Class I
"1. PCI is indicated in a non-infarct artery at a time separate from primary PCI in patients who have spontaneous symptoms of myocardial ischemia. (Level of Evidence: C)"
Class IIa
"1. PCI is reasonable in a non-infarct artery at a time separate from primary PCI in patients with intermediate- or high-risk findings on noninvasive testing.[2][3][4] (Level of Evidence: B)"

Implantable Cardioverter-Defibrillator Therapy Before Discharge (DO NOT EDIT)[1]

Class I
"1. Implantable cardioverter-defibrillator therapy is indicated before discharge in patients who develop sustained ventricular tachycardia/ventricular fibrillation more than 48 hours after STEMI, provided the arrhythmia is not due to transient or reversible ischemia, reinfarction, or metabolic abnormalities.[5][6][7] (Level of Evidence: B)"

Noninvasive Testing for Ischemia Before Discharge (DO NOT EDIT)[1]

Class I
"1. Noninvasive testing for ischemia should be performed before discharge to assess the presence and extent of inducible ischemia in patients with STEMI who have not had coronary angiography and do not have high-risk clinical features for which coronary angiography would be warranted.[8][9][10] (Level of Evidence: B)"
Class IIb
"1. Noninvasive testing for ischemia might be considered before discharge to evaluate the functional significance of a noninfarct artery stenosis previously identified at angiography. (Level of Evidence: C)"
"2. Noninvasive testing for ischemia might be considered before discharge to guide the post-discharge exercise prescription. (Level of Evidence: C)"

Sources

  • 2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 O'Gara PT, Kushner FG, Ascheim DD; et al. (2012). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e3182742c84. PMID 23247303. Unknown parameter |month= ignored (help)
  2. ↑ Hannan EL, Samadashvili Z, Walford G; et al. (2010). "Culprit vessel percutaneous coronary intervention versus multivessel and staged percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel disease". JACC Cardiovasc Interv. 3 (1): 22–31. doi:10.1016/j.jcin.2009.10.017. PMID 20129564. Unknown parameter |month= ignored (help)
  3. ↑ Erne P, Schoenenberger AW, Burckhardt D; et al. (2007). "Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial". JAMA. 297 (18): 1985–91. doi:10.1001/jama.297.18.1985. PMID 17488963. Unknown parameter |month= ignored (help)
  4. ↑ Madsen JK, Grande P, Saunamäki K; et al. (1997). "Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction (DANAMI). DANish trial in Acute Myocardial Infarction". Circulation. 96 (3): 748–55. PMID 9264478. Unknown parameter |month= ignored (help)
  5. ↑ Wever EF, Hauer RN, van Capelle FL; et al. (1995). "Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors". Circulation. 91 (8): 2195–203. PMID 7697849. Unknown parameter |month= ignored (help)
  6. ↑ Siebels J, Kuck KH (1994). "Implantable cardioverter defibrillator compared with antiarrhythmic drug treatment in cardiac arrest survivors (the Cardiac Arrest Study Hamburg)". Am. Heart J. 127 (4 Pt 2): 1139–44. PMID 8160593. Unknown parameter |month= ignored (help)
  7. ↑ Connolly SJ, Hallstrom AP, Cappato R; et al. (2000). "Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg . Canadian Implantable Defibrillator Study". Eur. Heart J. 21 (24): 2071–8. doi:10.1053/euhj.2000.2476. PMID 11102258. Unknown parameter |month= ignored (help)
  8. ↑ Théroux P, Waters DD, Halphen C, Debaisieux JC, Mizgala HF (1979). "Prognostic value of exercise testing soon after myocardial infarction". N. Engl. J. Med. 301 (7): 341–5. doi:10.1056/NEJM197908163010701. PMID 460322. Unknown parameter |month= ignored (help)
  9. ↑ Villella A, Maggioni AP, Villella M; et al. (1995). "Prognostic significance of maximal exercise testing after myocardial infarction treated with thrombolytic agents: the GISSI-2 data-base. Gruppo Italiano per lo Studio della Sopravvivenza Nell'Infarto". Lancet. 346 (8974): 523–9. PMID 7658777. Unknown parameter |month= ignored (help)
  10. ↑ Leppo JA, O'Brien J, Rothendler JA, Getchell JD, Lee VW (1984). "Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction". N. Engl. J. Med. 310 (16): 1014–8. doi:10.1056/NEJM198404193101603. PMID 6708976. Unknown parameter |month= ignored (help)


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