ACS in afya

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STEMI - Sx with new ST elevation on ECG
NSTEMI - Sx but no ST elevation but positive TNT (>1.2 rise over > 3 hrs)
UA - Sx with normal ECG and TNT
 
GRACE - Global Registry of Acute Cardiac Events
5 levels from <1.5% to >9% 6/12 mortality (3%, 6%)
age
Hx MI / PCI / CABG
BP pulse and ECG (looking for ischaemia)
troponin, creatinine, glc, Hb
 
''Antithrombin'' - provided not high bleeding risk
use unfractionated heparin if angiography within 24 hours
use Fondaparinux (sim to LMWH) if angiography >24hours

''Antiplatelet'' (glycoprotein IIb/IIIa inhibitors - GPI)
Tirofiban or Eptifibatide - use for 6/12 mortality >3%
?abciximab - if undergoing PCI
use with heparin
?Prasugrel
Aspirin / Clopidogrel
 
High risk of bleeding
age, bleeding complications, renal impariment, low body weight
 
All pts with risk <3% should have LV function assessed pre-discharge and then monitoured as it can change (up and down) - ischaemia testing unless still Sx - then angiography - if pos ischaemia test then angiography
All pts with risk >3% - angiography with PCI / revascularisation as required

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