Guest Nick Servati, PharmD, BCCP discusses various topics on Acute Coronary Syndromes (ACS) including pathophysiology and clinical presentation, debunking MONA myths, P2Y12 pretreatment, thrombolytics, anticoagulation, and vasopressors/inotropes. Also covered are IV antiplatelet agents, a STEMI pharmacotherapy checklist, future research and take-home points.
The podcast discusses the pathophysiology of acute coronary syndrome (ACS) and the differences in symptoms between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI).
The episode covers the current guidelines for ACS management, including the limitations of certain interventions like morphine and oxygen, and the benefits of using aspirin. It also explores patient-specific factors and best practices for transitioning from IV to oral antiplatelet therapies.
The podcast emphasizes the spectrum of ACS, from unstable angina to acute myocardial infarction (MI), and discusses the potential risks and benefits of using morphine, oxygen, nitrates, and aspirin (MONA) in ACS management. It also explores the timing and selection of interventions like thrombolytics and IV antiplatelet agents, considering patient-specific factors and drug interactions.
Deep dives
Acute Coronary Syndrome Overview
In this podcast episode, the speaker discusses acute coronary syndrome (ACS), specifically focusing on ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). They cover topics such as the pathophysiology of ACS, differences in symptoms between STEMI and NSTEMI, and the use of morphine, oxygen, nitrates, and aspirin (MONA) in ACS management. They also explore the timing and indications for thrombolytic therapy, considerations for IV antiplatelet agents, and the choice between epinephrine and norepinephrine in cardiogenic shock. Finally, they discuss transitioning from IV antiplatelet therapy to oral P2Y12 inhibitors. Overall, this episode provides a comprehensive overview of the main concepts and considerations in ACS management.
Guidelines for ACS Management
This podcast episode analyzes the current guidelines for acute coronary syndrome (ACS) management. It highlights the limitations of certain interventions like morphine and oxygen, as well as the benefits of using aspirin in ACS patients. The episode delves into the use of P2Y12 inhibitors and glycoprotein IIb/IIIa inhibitors, emphasizing patient-specific factors and best practices for transitioning from IV to oral antiplatelet therapies. The speaker also discusses the diverse management strategies for cardiogenic shock, including the use of inotropes and vasopressors. By exploring these guidelines, this episode offers valuable insights into evidence-based approaches for ACS management.
Considerations in ACS Treatment
This podcast episode delves into several important considerations in the treatment of acute coronary syndrome (ACS). The speaker emphasizes the spectrum of ACS, ranging from unstable angina to acute myocardial infarction (MI), and highlights the significance of EKG findings in differentiating between the two. They discuss the potential risks and benefits of using morphine, oxygen, nitrates, and aspirin (MONA) in ACS management, while also addressing the evolving guidelines surrounding their use. Additionally, the episode explores the timing and selection of interventions like thrombolytics and IV antiplatelet agents, and offers insights into patient-specific factors and drug interactions. Overall, this episode provides valuable information and considerations for healthcare professionals involved in ACS treatment.
Choosing between antiplatelet agents in ACS management
When it comes to antiplatelet therapy in the management of acute coronary syndrome (ACS), the choice between ticagrelor and prasugrel can be patient-specific. Factors such as the type of ACS (NSTEMI or STEMI), bleeding risk, and the need for coronary artery bypass grafting (CABG) should be considered. Additionally, the duration of dual antiplatelet therapy and the platelet reactivity units should be monitored to ensure optimal outcomes.
Tailoring treatment based on patient characteristics in cardiogenic shock
In the management of cardiogenic shock, a patient-specific approach is crucial. Factors such as right ventricular involvement, risk of pulmonary vascular resistance, and the need for mechanical circulatory support should guide the choice of inotropes and vasopressors. Millirinone may be preferred for patients with right-sided failure, while dopamine and norepinephrine can be used simultaneously to maintain perfusion to end organs and improve cardiac function acutely.
