On Easter Monday we talked about a patient I saw with an NSTEMI
who was admitted for pancreatitis.
NSTEMI doesn't seem to get the same
attention as STEMI among medical students probably because it doesn't sound as
sexy. However it can be a more challenging problem because its difficult to
assess who will go to a full on STEMI or who will perfuse that coronary artery.
We use the TIMI score to classify patients
in terms of high, medium or low risk: chance of reoccurance MI or death at 14
days.
Management:
Make sure we have good IV access, put the
patient on a monitor, consider CCU consult.
Aspirin, plavix, heparin and usually beta
blocker are standard therapy. I will email out a presentation out on this as it
is obviously alot more complicated.
Note: ticagrelor was superior to plavix in
the relatively recent PLATO trial. Interesting, ticagrelor doesn't need to be
metabolized before it gets active, potentially some patients were that to be
slow metabolizers of plavix.
When to take patient to cath asap?
arrhythmia's
Heart failure
non-resolving chest pain
new murmur possibly suggesting ischemia to
papillary muscle of mitral valve
As per the TIMCS trial, there was benefit in high risk patient –
went to cath in 24 hours
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