急性心肌梗塞处理字母歌.pptVIP

急性心肌梗塞处理字母歌 Each year ≈800 000 persons in the United States experience AMI, and ≈213,000 of them die. At least one half of these persons die within 1 hour of onset of symptoms and before reaching a hospital emergency department. What is AMI? a targeted clinical examination and a 12-lead ECG within 10 minutes and a door-to-needle time that is 30 minutes. World Health Organization (WHO) definition, the diagnosis of MI is based on the presence of ≥2 of the following 3 criteria: (1) a clinical history of ischemic-type chest discomfort, (2) changes on serially obtained electrocardiographic tracings, and (3) a rise and fall in serum cardiac markers. A-Aspirin/ACEI Aspirin:300mg Chewed in ED, then 300mg/d at least 1 week, then? Ticlopidine and Clopidogrel? Tirofiban(GPIIa/IIIb): 0.4ug/kg/min over 30 min, then infuse 0.1ug/kd/min for non-ST elevated MI patients at high-risk (elevated serum markers, refractory ischemia) ACEI: within hours, at least 6 weeks, if no contraindication. Initial dose 6.25mg captopril followed by 12.5mg 2 hrs later, 25mg 10-12 hrs later, then 50mg bid. Or lisinopril 5mg initially,5mg after24 hrs, 10 mg after 48 hrs, then 10 mg daily. Longer if Sx CHF or LVEF ≤40% B-Beta-blocker early by intravenous, followed by oral therapy, if no contraindication. IV Metoprolol (up to 15mg in 3 divided doses) or IV Atenolol (10mg in 2 divided doses) Oral Metoprolol 50-100mg daily or atenolol 50-100mg qd or other beta blockers After discharg? Cautions/Relative Contraindications: Heart rate60 bpm; PR interval0.24 seconds; severe PVD; SAP100mmHg; 2nd or 3rdo AV block; IDDM; Signs of peripheral hypoperfusion; severe COPD; severe LV failure; Hx of Asthma C-Coagulation Heperin: IV in alteplase, reteplase, PTCA treated patients and non-ST elevation MI; large of ant. MI, AF, prior embolus, LV thrombus 60U/hr bolus, infusion 12 U/kg/hr (max 4000U bolus/1000U/hr infusion for pts70kg) to maintain aPTT 50-70 seconds Coumadin for 3-6 months if LV thrombus seen or thromboem