Acute Coronary Syndrome (basic) - Ramathibodi - Wisuit - June 2014

Acute Coronary Syndrome

Wisuit Katekao, MD

Thursday, June 26, 14

• ST-segment elevation MI

• Non ST-segment elevation MI

• Unstable Angina

Normal EKG

ACC 2013 Definition

• New-LBBB

• New-STE for 2 contiguous leads

• > 2 mm in men , 1.5 mm in women (V2-V3)

• > 1 mm in other chest leads & limb leads

New-LBBB

Primary PCI

• 1st - ASA ให้แน่นอน 162-325 mg

• 2nd - เลือกเอาระหว่าง 3 ตัวดังนี้ load ASAP

• Clopidogrel 600mg

• Prasugrel 60mg

• Ticagrelor 180mg

Primary PCI

• Heparin - ให้ bolus ระหว่าง cath

• ถ้ามี IIb/IIIa = ให้ UFH 50-70 u/kg IV

• ถ้าไม่ได้ = ให้ UFH 70-100 u/kg IV

• No role for ENOXA & Fonda !!!

Fibrinolytic

Thrombolytics

• 1st - ASA ให้แน่นอน 162-325 mg

• 2nd - ให้ได้แค่ Clopidogrel เท่านั้น

• อายุน้อย < 75 --- 300mg load

• แก่ > 75 --- ให้แค ่75mg ก็พอ เพราะกลัว bleed !!!

ST depression

STE aVR & V1

Digoxin Intox

Acute Coronary Syndrome (basic) - Ramathibodi - Wisuit - June 2014

denition newlbbb newste

acs stsegment elevation

st depression

ukg iv

contiguous leads

load asap clopidogrel

ste avr v1

women v2v3

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