STEMI

Devin Welke
Mind Map by Devin Welke, updated more than 1 year ago
Devin Welke
Created by Devin Welke almost 6 years ago
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Description

STEMI

Resource summary

STEMI
  1. MONA
    1. Beta Blocker
      1. Primary PCI
        1. Abciximab ASAP before PCI
          1. Alternative GP IIb/IIIa inhibitor
        2. Thrombolytic
          1. Tissue Plasminogen Activators
            1. Non-selective (not used)
              1. Streptokinase
                1. Anistreplase
                  1. Urokinase
                  2. Selective
                    1. Alteplase
                      1. Reteplase
                        1. Tenecteplase
                      2. Anticoagulation with thrombolysis for >48 h
                        1. d/c after PCI or CABG
                          1. UFH 60 units/kg bolus then 12 units/kg/h
                            1. Monitor aPTT and H/H
                            2. IF <75 enoxaparin 30 mg IV bolus then 1 mg/kg SQ q12
                              1. If >75 no bolus and 0.75 mg/kg SQ BID
                                1. CrCl <30 ml/min use 1 mg/kg SQ q24h
                                  1. Contraindicated in dialysis pts.
                                2. Fondaparinux 2.5 mg IV bolus then 2.5 mg SQ q24h
                                  1. Monitor H/H and SCr
                                    1. Contraindicated in CrCl <30 ml/min
                                3. If stented, add clopidogrel
                                  1. 300 mg load if <75
                                    1. Withhold >5 days pre-CABG
                                    2. Prasugrel
                                      1. NOT studied with medical management (thrombolytic monotherapy)
                                      2. Ticagrelor
                                        1. 180 mg load then 90 mg BID
                                        2. Aldosterone Antagonists
                                          1. Statin
                                            1. ACEi
                                              1. Start after SL nitroglycerin, beta blocker
                                                1. Lifelong if LV dysfunction, HF, anterior MI
                                                  1. Caution hypotenstion and chronic renal failure
                                                    1. Contraindicated in acute renal failure
                                                      1. Oral only, no IV
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