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402: Acute Coronary Syndromes

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Acute Coronary Syndrome STEMI Non-STEMI Stable Angina Unstable Angina Stable Angina Unstable Angina MONA Acute MI symptoms Troponin CK2 Right coronary artery Left anterior descending artery Circumflex coronary artery Statins Statins MI Clopidogrel Aspirin Abciximab Alteplase Left heart catheter Ventriculogram

Unstable angina, leads to MI Transmural MI Subendocardial MI Results from atherosclerosis. Results from thrombosis, breaking of weak cap. Predictable with exercise, subsides with rest, perhaps nitro. Comes unexpectedly, lasts longer than 15 minutes. Morphine, Oxygen, Nitroglycerin, Aspirin Sudden fatigue, perhaps no pain, SOB, anxiety Present in blood, 3 hrs to 10 days after MI Present in blood 3-6 hrs after MI supplies RA, RV, SA, AV supplies anterior wall of LV

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Post PTCA care

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hold pressure 15-20 min, instruct pt to hold when coughing, sneezing & report drainage, head of bed lower than 45 degrees for 2-6 hrs, pt not to lift head off of pillow heart pain with fever

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Pericarditis

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supplies lateral and posterior wall of LV and 2/3 of septum can cause rhabdomylitis inhibit HMG-CoA reductase can cause arrhythmias antiplatelet, ADP receptor antagonist antiplatelet, cox inhibitor antiplatelet, GII/III receptor antagonist TPA, thrombolytic drug catheter inserted into L artery and threaded into left ventricle Contrast injected into L ventricle to measure wall function and ejection fraction Catheter inserted into right vein, enters right ventricle Catheter introduces balloon into coronary artery, inflates to reduce thrombus to less than 50% lumen obstruction. pt on IV heparin, nitroglycerin, and abciximab placed with balloon percutaneously, holds artery open after balloon is removed

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Right heart catheter PTCA

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Coronary stent

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