Which of the following is not a part of diagnostic criteria of acute MI in WHO criteria? (PNQ)
|C||Cardiac enzyme rise|
When assessed angiographically, flow in the culprit coronary artery is described by a simple qualitative scale called the thrombolysis in myocardial infarction (TIMI) grading system:
Grade 0 indicates complete occlusion of the infarct-related artery;
Grade 1 indicates some penetration of the contrast material beyond the point of obstruction but without perfusion of the distal coronary bed;
Grade 2 indicates perfusion of the entire infarct vessel into the distal bed but with flow that is delayed compared with that of a normal artery;
Grade 3 indicates full perfusion of the infarct vessel with normal flow.
1. Oral Antiplatelet (Ref. Hari-18th ed., Pg- 2019)
a. Aspirin reduces mortality by 34%. (AIIMS Nov 2008)
2. Intravenous antiplatelet therapy
a. Unfractionated heparin (UFH)
4. Beta blockers:
6. Calcium antagonists: diltiazem (in Prinzmetal angina). (AIIMS May 2011)
7. Statin if total cholesterol is high
8. K+ channel activator, eg Nicorandill
9. Ranolazine – It is new anti anginal drug useful for refractory angina. (AIIMS May 2011)
Ranolazine, use for patients with chronic angina who continue to be symptomatic despite a standard medical regimen. The mechanism – it inhibits the late inward sodium current (INa).
Extra Edge: Indication of revascularization & CABG (Ref. Hari-18th ed., Pg- 2013)
1. Patients with an unacceptable level of angina despite optimal medical management be considered for coronary revascularization.
2. Patients with single- or two-vessel disease with normal LV function and anatomically suitable lesions ordinarily are advised to undergo PCI.
3. Patients with three-vessel disease (or two-vessel disease that includes the proximal left descending coronary artery) and impaired global LV function (LV ejection fraction < 50%) or diabetes mellitus and those with left main coronary artery disease or other lesions unsuitable for catheter-based procedures should be considered for CABG as the initial method of revascularization.
A. Percutaneous transluminal coronary angioplasty (PTCA)
a. Involves balloon dilatation of the stenotic vessel(s).
b. Stenting reduces restenosis rates.
c. Drug-coated stents reduce restenosis. Drug use is
a. Rapamycin (Sirolimus)
b. Paclitaxel (MCQ)
d. Antiplatelet agents, eg clopidogrel reduce the risk of stent thrombosis.
e. IV platelet glycoprotein IIb/IIIa- inhibitor can reduce procedure-related ischemic events.
Example: eptifibatideQ, tirofiban, abciximab
B. Thrombolysis: Hemorrhage is the most frequent and potentially the most serious complication.
Recent Advances: Triflusal (New Drug)
Triflusal is a platelet aggregation inhibitor
Mechanism of action:
Triflusal is a platelet antiaggregant through;
1. Blocks cyclooxygenase inhibiting thromboxane A2, preventing aggregation.
2, Preserves vascular prostacyclin, thus promoting antiaggregant effect
3. Blocks phosphodiesterase thereby increasing cAMP concentration, thereby promoting antiaggregant effect due to inhibition of calcium mobilization