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Common Congenital Heart Lesions - page 46 / 126

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Treatment of ACS

  • Focused on reducing myocardial damage & the risk of complications

  • Addresses:

    • Inciting intracoronary thrombus

    • Imbalance b/t myocardial O2 supply & demand

  • Although certain therapeutic aspects are common to all ACS, there’s a critical

difference in how STEMI is treated compared to UA & NSTEMI

  • General in-hospital measures for ACS include:

    • Continuous ECG monitoring—to detect arrhythmias

    • Bed rest—to reduce myocardial O2 demand

    • Supplemental O2—to improve perfusion & increase O2 supply

    • Analgesics (ie. morphine)—to relieve chest pain & anxiety

Acute Treatment of UA & NSTEMI

  • Treatment consists of:

    • Antithrombotic Therapy—stabilizes the thrombus & prevent its further intrusion into coronary lumen while facilitating its dissolution

  • Antischemic Therapy—restores the balance b/t myocardial O2 supply & demand

  • “Early Invasive Approaches—includes cardiac catherization & coronary revascularization; most beneficial in patients with severe UA & NSTEMI (ie. patients presenting with ST-T deviations at presentation, elevated serum biomarkers, & multiple cardiac risk factors)

Antithrombotic Therapy (includes anti-platelet & anticoagulants)

Anti-platelets

  • AspirinÆinhibition of TXA2 synthesis by plateletsÆinhibition of further platelet activation

  • Thienopyridines (ie. Ticlopine & Clopidogrel)Æinhibition of ADP-mediated platelet activation

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