Transcript Ventricular Tachycardia

Unstable Angina /Non-ST Elevation
Myocardial Infarction Critical
Pathway Toolkit
Adapted from Dr Chris Cannon
STRIVE Scientific Committee – 2008
Based on ACC/AHA Guidelines - 2007
Anticoagulants

Enoxaparin more effective in preventing combined
end point of death or MI vs Unfractionated heparin
(UFH).

Avoid cross-over during PCI
Last SC dose >8 hrs, 0.3 mg/kg of iv.
Last SC dose <8 hours, no additional
enoxaparin.
Anticoagulants

Bivalirudin (single therapy) lower risk of bleeding
compared to Enoxaparin and UFH.
Approved only for early PCI.

Fondaparinux
Lower risk of bleed but increased risk of catheterrelated thrombi, to switch to UFH in Cath Lab.
Lipid Management
 Fasting lipid profile workup within 24h [Class I, LOE: C]
 Statin regardless of LDL-C [Class I, LOE: A]
Beta-blockers
Ellis K, et al.
6-month mortality in ACS pts undergoing PCI
1.7% Beta-blockers vs 3.7% without beta-blockers.
(Pooled results from EPIC, EPILOG,
CAPTURE and EPISTENT
J Interv Cardiol 2003;16:299–305.)
RAPPORT,
Beta-blockers
ACC/AHA 2007 Class 1 (LOE B)#
Oral therapy initiated ≤24 h if NO
 Heart failure
 Low-output state
 Increased risk for cardiogenic shock
 Relative contraindications
 PR ›0.24 s
 2nd or 3rd degree heart block
 Reactive airway disease
Angiotensin-aldosterone inhibitors
 Pulmonary congestion or LVEF ≤ 40% ACEI within 24h or ARB if intolerant.
 LV dysfunction, hypertension or diabetes –
Long-term ACEI or ARB.
 LVEF ≤ 40% and symptomatic heart failure
or diabetes
(without renal dysfunction/hyperkalemia)
Aldosterone-receptor blockade in addition to ACEI.
Optimal Discharge Planning
 Optimal blood pressure
<140/90 mm Hg [Class I, LOE: A]
<130/80 in diabetes or chronic kidney disease mm Hg
[Class I, LOE: A]
 Discharge education
Medication use, cardiac rehabilitation, lifestyle modification
(diet, exercise & smoking cessation) [Class I, LOE: C]
 Follow-up
2-6 weeks in low risk, medically treated, revascularized,
14 days high risk [ Class I, LOE: C]
Cardiac Admission Checklist
Cardiac Admission Checklist
Cardiac Discharge Prescription
Adapted by
Kamelia Emamian M.D.
and Thao Huynh, MD, MSC.