| Popis: |
The first step in inpatient management of acute coronary syndrome (ACS) is determining whether the patient has ST-segment elevation myocardial infarction (STEMI). For STEMI, the initial approach to management is cardiac catheterization with percutaneous coronary intervention (PCI) to reperfuse the blocked artery; PCI should take place within 120 minutes of first medical contact. However, if no contraindications are present, fibrinolytic therapy is preferred if PCI will take more than 120 minutes. In ACS without STEMI, cardiac catheterization with PCI is the recommended approach for patients who are unstable, and for stable patients with high risk assessment scores, diabetes or renal insufficiency, stent placement within the past 6 months, or prior bypass surgery. Treatment of patients with ACS who do not meet the previously discussed criteria can be noninvasive when troponin levels are not elevated, no ST-segment elevations or depressions are present on electrocardiogram, and risk assessment scores are low. Assuming no contraindications exist, all patients with or without STEMI should receive medical therapy that includes nitroglycerin, antiplatelet agents, anticoagulants, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, aldosterone blockade if left ventricular function is impaired, beta blockers, and statins. |
