Medical Management
Treatment
The American College of Cardiology (ACC) and American Heart Association (AHA) released the guidelines on the management of STEMI and NSTEMI in 2013 and 2014, respectively. Mrs. B will be treated based on these guidelines. Immediately on arrival, she will receive the following treatments: supplemental oxygen therapy to keep oxygen saturation greater than 90% or relieve respiratory distress, sublingual nitroglycerin to relieve ischemic pain, and chewable 325mg aspirin for its antiplatelet effect. Morphine sulfate will be considered if chest pain is not relieved by sublingual nitroglycerin or if anxiety or pulmonary edema is present. Following the initial treatment, the treatment plan for Mrs. B will depend on whether she is diagnosed with STEMI, NSTEMI, or unstable angina. Each case will be discussed briefly:
STEMI treatment. Mrs. B will receive a loading dose of 600mg clopidogrel and will be started on heparin drip. Reperfusion therapy needs to be performed as soon as possible. PCI is the preferred method, and the goal is 90 minutes or less door-to-balloon time. If PCI is not available, fibrinolytic therapy should be administered unless it is contraindicated.
NSTEMI or unstable angina treatment. Mrs. B will be started on heparin drip. If she continues to have chest pain, nitroglycerin drip will be started. Mrs. B will be prepared for PCI for early revascularization, since she is considered to be at high risk for recurrent ACS or mortality. Mrs. B’s stenosis could be treated with PIC. However, individuals with significant coronary disease may need coronary artery bypass grafting (CABG). Optimal medical therapy post-ACS includes antiplatelet therapy, beta blocker, nitrate, short-acting non-dihydropyridine calcium channel blocker, and statin. In Mrs. B’s case, she will be started on lifelong 81mg aspirin therapy, 75mg Plavix for a year, and lifelong 80mg atorvastatin. The following medication will be started within 24 hours at minimum dose and titrated as tolerated: metoprolol tartrate twice a day and Lisinopril once a day. Mrs. B’s treatment plan will also incorporate nonpharmacological treatment, such as lifestyle modification consulting and cardiac rehabilitation referral. Upon discharge, she will be provided pharmacological therapy and nonpharmacological resources to help her with smoking cessation. Monitoring Mrs. …show more content…
B will be monitored for the success of reperfusion therapy, arrhythmias, heart failure signs and symptoms, pericarditis, pericardial effusion, and cardiogenic shock. Post hospitalization, Mrs. B needs to establish care with a cardiologist. O 'Gara et al. (2013) recommend left ventricle (LV) function assessment for patients with lower LV function in 40 days. If LV function is not improved, the patient needs to be evaluated for implantable cardioverter defibrillator (ICD) insertion to prevent sudden cardiac death. Patients, especially those with drug-eluting stents, need to be monitored for antiplatelet compliance. Mrs. B will also need to follow up with her primary care provider for ECG, BMP, CBC, hemoglobin A1C, and LFT. Outcome The outcome of a patient who suffered from ACS depends on the presence of extended damage on myocardial tissue and comorbidity. In general, these patients will face increased risk of mortality, developing chronic heart disease, and recurrent ACS. About 37% of these patient will die in the same year (Bashore et al., 2016). Comorbidities such as diabetes mellitus, extracardiac arterial disease, and hypertension are major risk factors for poor outcomes. Patients with diabetic mellitus have greater than a 30 % increase in poor outcomes (Amsterdam et al., 2014). AMI in the Elderly and Women Typical ACS symptoms are not
Treatment
The American College of Cardiology (ACC) and American Heart Association (AHA) released the guidelines on the management of STEMI and NSTEMI in 2013 and 2014, respectively. Mrs. B will be treated based on these guidelines. Immediately on arrival, she will receive the following treatments: supplemental oxygen therapy to keep oxygen saturation greater than 90% or relieve respiratory distress, sublingual nitroglycerin to relieve ischemic pain, and chewable 325mg aspirin for its antiplatelet effect. Morphine sulfate will be considered if chest pain is not relieved by sublingual nitroglycerin or if anxiety or pulmonary edema is present. Following the initial treatment, the treatment plan for Mrs. B will depend on whether she is diagnosed with STEMI, NSTEMI, or unstable angina. Each case will be discussed briefly:
STEMI treatment. Mrs. B will receive a loading dose of 600mg clopidogrel and will be started on heparin drip. Reperfusion therapy needs to be performed as soon as possible. PCI is the preferred method, and the goal is 90 minutes or less door-to-balloon time. If PCI is not available, fibrinolytic therapy should be administered unless it is contraindicated.
NSTEMI or unstable angina treatment. Mrs. B will be started on heparin drip. If she continues to have chest pain, nitroglycerin drip will be started. Mrs. B will be prepared for PCI for early revascularization, since she is considered to be at high risk for recurrent ACS or mortality. Mrs. B’s stenosis could be treated with PIC. However, individuals with significant coronary disease may need coronary artery bypass grafting (CABG). Optimal medical therapy post-ACS includes antiplatelet therapy, beta blocker, nitrate, short-acting non-dihydropyridine calcium channel blocker, and statin. In Mrs. B’s case, she will be started on lifelong 81mg aspirin therapy, 75mg Plavix for a year, and lifelong 80mg atorvastatin. The following medication will be started within 24 hours at minimum dose and titrated as tolerated: metoprolol tartrate twice a day and Lisinopril once a day. Mrs. B’s treatment plan will also incorporate nonpharmacological treatment, such as lifestyle modification consulting and cardiac rehabilitation referral. Upon discharge, she will be provided pharmacological therapy and nonpharmacological resources to help her with smoking cessation. Monitoring Mrs. …show more content…
B will be monitored for the success of reperfusion therapy, arrhythmias, heart failure signs and symptoms, pericarditis, pericardial effusion, and cardiogenic shock. Post hospitalization, Mrs. B needs to establish care with a cardiologist. O 'Gara et al. (2013) recommend left ventricle (LV) function assessment for patients with lower LV function in 40 days. If LV function is not improved, the patient needs to be evaluated for implantable cardioverter defibrillator (ICD) insertion to prevent sudden cardiac death. Patients, especially those with drug-eluting stents, need to be monitored for antiplatelet compliance. Mrs. B will also need to follow up with her primary care provider for ECG, BMP, CBC, hemoglobin A1C, and LFT. Outcome The outcome of a patient who suffered from ACS depends on the presence of extended damage on myocardial tissue and comorbidity. In general, these patients will face increased risk of mortality, developing chronic heart disease, and recurrent ACS. About 37% of these patient will die in the same year (Bashore et al., 2016). Comorbidities such as diabetes mellitus, extracardiac arterial disease, and hypertension are major risk factors for poor outcomes. Patients with diabetic mellitus have greater than a 30 % increase in poor outcomes (Amsterdam et al., 2014). AMI in the Elderly and Women Typical ACS symptoms are not