Judd E. Hollander
General., Measures Reperfusion Fibrinolytics
Mechanical, Reperfusion Antiplatelet ..Agents Antithrombins Direct., Thrombin., .Inhibitors Limiting, .Infarct Size Nitrates b.Blockers
AngiotensinM-conyerti1ng..E,nzY,me, .Inhibitors Magnesium
Calcium-Channel Antagonists Special Issues in Treatment of AMIComplications
Cardiogenic Shock Right Ventricular. Infarction Selected.Dysrhythmias, in ..AM,' Cocaine, Assocjated.Myocardial .Ischemia
Acute coronary care syndromes (ACS) can be inhibited or reversed with a wide variety of interventions. In this chapter, major therapeutic treatment trials are summarized. Where available, evidence-based consensus panel treatment recommendations are provided. Some dosage recommendations are intentionally not provided because ongoing clinical trials are likely to result in changed dosing strategies.
Treatment of ACS is individualized based on duration and persistence of symptoms, cardiac history, and findings on physical examination and initial electrocardiogram. Generally speaking, patients with persistent symptoms and ST-segment elevation should receive therapy or mechanical reperfusion (angioplasty). Treatment with heparin, b antagonists, nitrates, and angiotensin-converting enzyme inhibitors should be considered, based on symptoms, vital signs, and the presence or absence of heart failure. Patients with unstable angina or non-Q-wave infarctions without ST-segment elevation should be treated with aspirin and heparin, and possibly b antagonists and nitrates. Patients refractory to these therapies or patients scheduled to undergo percutaneous interventional procedures also benefit from the use of glycoprotein IIb/IIIa antagonists.
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