Acute Coronary Syndromes

Acute Coronary Syndromes on Prezi

Acute Coronary Syndromes 2010 AHA Guidelines for CPR and ECC  Circulation. 2010;122:S787-S817 ACC/AHA 2009 Guidelines for STEMI and PCI Circulation. 2009;120;2271-2306 ACC/AHA 2007 Guidelines for UA/NSTEMI Circulation. 2007;116;e148-e304

TIMI Risk Score

• Age ≥ 65 years
• At least 3 risk factors for CAD (family history of CAD, hypertension, hypercholesterolemia, diabetes, or current smoker)
• Prior coronary stenosis of ≥ 50%
• ST-segment deviation on ECG
• At least 2 anginal events in prior 24 hours
• Use of aspirin in prior 7 days
• Elevated serum cardiac biomarkers

PCI Following ROSC After Cardiac Arrest

• Patients with OHCA due to VF in the setting of STEMI or new LBBB, emergent angiography with prompt recanalization of the infarct-related artery is recommended (Class I, LOE B).
• PPCI after ROSC in subjects with arrest of presumed ischemic cardiac etiology may be reasonable, even in the absence of a clearly defined STEMI (Class IIb, LOE B).
• Appropriate treatment of ACS or STEMI, including PCI or fibrinolysis, should be initiated regardless of coma (Class I, LOE B)

Management of Arrhythmias

• Primary VF accounts for the majority of early deaths during AMI. The incidence of primary VF is highest during the first 4 hours after onset of symptoms.
• Prophylactic antiarrhythmics are not recommended for patients with suspected ACS or MI in the prehospital or ED (Class III, LOE A).
• Routine IV administration of beta-blockers to patients without hemodynamic or electric contraindications is associated with a reduced incidence of primary VF (Class IIb, LOE C).
• Low serum potassium has been associated with ventricular arrhythmias. It is prudent clinical practice to maintain serum potassium >4 mEq/L (Class IIB, LOE A).