Rejected
at 10:30 p.m. Oct, 31, 2023 ]
by
Joe
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Doc_MMJan
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What is the most appropriate initial therapy for a hemodynamically stable patient with chest pain and suspected acute coronary syndrome and low risk for aortic dissection?
{{c1::Aspirin}}
Extra
Reduces both the rate of myocardial infarction and overall mortality in patients with ACS
| STEMI Initial Management | |
| ACE inhibitor | - Reduces fatal and nonfatal cardiac events, prevents cardiac remodeling; especially for patients with anterior MI and EF < 40% |
|---|---|
| Angiotensin receptor blocker (ARB) | - Given if the patient cannot tolerate ACE inhibitor (e.g., due to cough) |
| Aspirin | - Inhibits platelet aggregation; given before PCI or fibrinolysis |
| Atorvastatin | - Reduces ischemic complications, resolves ST segment elevation in patients undergoing PCI, lowers LDL levels - Recommended for all STEMI patients without contraindication to statin therapy |
| B-blocker | - Alleviates chest pain by reducing heart rate and contractility (reduces oxygen demand) - May prevent reinfarction and ventricular fibrillation - Not given in cardiogenic shock |
| Clopidogrel | - Inhibits platelet aggregation; - Given before PCI or fibrinolysis |
| Heparin | - Prevents clot formation; given before PCI or fibrinolysis |
| Morphine | - Alleviates chest pain by stimulating opioid receptors - Given if chest pain persists despite nitroglycerin - May cause hypotension or heart block |
| Nitroglycerin | - Alleviates chest pain by causing vasodilation, reducing preload and afterload (reduces oxygen demand), and improving myocardial perfusion (increases oxygen supply) - May cause hypotension |
| Platelet glycoprotein IIb/IIIa antagonist | - Inhibits platelet aggregation; given before PCI |
| Supplemental oxygen | - Only for patients with low oxygen saturation |
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