Cardiology
Acute Coronary Syndromes
Cardiology

Acute Coronary Syndromes

STEMI, NSTEMI, unstable angina, cocaine MI, Prinzmetal.

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◆STEMI

  • •ECG: ST elevation in contiguous leads
  • •Aspirin + P2Y12 + heparin + statin + BB + nitrate (avoid if RV infarct/hypotensive)
  • •Reperfusion: PCI ≤90 min door-to-balloon; thrombolytics ≤30 min if PCI not available within 120 min
  • •DAPT ≥12 months after DES

◆NSTEMI / unstable angina

  • •Ischemic ECG + positive troponin = NSTEMI
  • •Ischemic ECG + negative troponin = unstable angina
  • •Repeat troponin in 3–6 hr if early negative
  • •DAPT + anticoagulation; TIMI/GRACE risk stratification
  • •Early invasive (<24 hr) for high-risk

◆Prinzmetal (vasospastic)

  • •Rest pain, often early morning; transient ST elevation that resolves
  • •Smoking is major RF
  • •Clean coronaries on angiography
  • •Treat: CCB (diltiazem, amlodipine) + nitrates; AVOID beta-blockers

◆Cocaine-induced MI

  • •Sympathetic surge → vasospasm + thrombosis
  • •Benzodiazepines FIRST (reduce sympathetic drive)
  • •Nitrates + ASA + phentolamine
  • •AVOID beta-blockers (unopposed alpha)
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