All of the fallowing are complications of streptokinase? (PGI May 2010)
Joint pain, B . Intracranial bleed, C . Fever, D . Anaphylaxis
Management of acute coronary syndrome (ACS)
1. Aspirin 300mg chewed
2. GTN sublingual.
3. Analgesia Morphine 2-3 mg IV or 10 – 15 mg IM
4. Thrombolysis, if no contraindication or primary angioplasty
Role of ACEI in acute MI
a. To control BP
b. To control LVF
c. To help in the remodeling of infarct tissue.
7. Low molecular weight heparin (eg enoxaparin).
8. GP IIb/ IIIa antagonist (eg tirofiban) used in High-risk patients (persistent or recurrent ischaemia, ST-depression, diabetes, raised troponin)
9. Clopidogrel, in addition to aspirin, should be considered for up to 12 months.
1. Warfarin is not used in treatment of Ac MI.
2. Triflusal reduces thromboxane synthesis so prevents platelet aggregation. It is an alternative to aspirin in secondary prophylaxis of CVA and MI.
3. (This is new drug. It is not given in Hari-18th Edition!!!)
4. Trimetazidine is controls myocardial ischemia through intracellular metabolic changes. It protect the heart from the deleterious effects of ischemia, and enhance LV contractility in patients with stunned or hibernating myocardium. (AIIMS Nov 09)
Recent advances in the management of MI
1. Enhanced external counter pulsation (Ref. Hari-18th ed., Pg-2013)
a. Enhanced external counterpulsation utilizes pneumatic cuffs on the lower extremities to provide diastolic augmentation and systolic unloading of blood pressure in order to decrease cardiac work and oxygen consumption while enhancing coronary blood flow.
b. Regular application improves angina, exercise capacity, and regional myocardial perfusion.
2. Trans myocardial LASER revascularization.
a. Transmyocardial laser revascularization (to increase intramyocardial channels of blood flow), and the currently experimental approaches of gene and stem cell therapies are under study. (Ref. Hari 17th ed., Pg-1526)
Note: About Trans myocardial LASER revascularization, it is mentioned in 17th edition but it is not there in 18th edition!