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AMI: Treatment

AMI: Treatment:

  • Oxygen
  • Diamorphine+Metoclopramide
  • Aspirin+Clopidogrel: 300mg
  • Thrombolysis: Alteplase, Reteplase, Streptokinase, Tenecteplase
  • Heparin: post-thrombolysis
  • Nitrates: GTN subling/iv; or ISDN IV
  • Betablocker: if no CI: Atenolol 5mg IV over 5min, repeat after 10min; or: Metoprolol; Long-term: Acebutolol, Metoprolol, Propranolol, Timolol; if LV dysfx: Carvedilol, Bisoprolol, long-acting Metoprolol [consider Verapamil (no other CCB), if BB contraindicated, and no LV dysfx]
  • ACEI/ARA: within 24h
  • DIGAMI:
  • Statin: + Omega-3-FA compounds +Ezetimibe +Fibrate (-Gemfibrozil)
  • Eplerenone: if HF, within 3-14d: 25mg od, then 50od (within 4 wks)

Heart Failure (Teaching Jan 2008, Dr Simon Williams)

  • CHARM'03: Candesartan in HF (LVEF<=40%): as alternative to ACEI: RR=0.7 (similar to ACEI), added to ACEI: RR=0.85 (i.e. added benefit) [although ~33% dropout, e.g. hi K]
  • Heart failure guidelines ESC 2005 (Upd)
  • NICE HF guidelines: 2003
  • OPTIMAAL: Losartan vs Captopril: less benefit post MI!
  • VALIANT: Valsartan post MI (within 3/12): similar benefit as ACEI, but no added effect
  • EPHESUS'01: Eplerenone 3-14d post MI, LVEF<40%, clinical HF or DM: 15% RRR death, 21% RRR sudden death; some icr in hi K, but even greater icr in preventing lo K
  • RALES: Spironolactone (>6/12 post MI)
  • uncertainty: Eplerenone vs Spironolactone 2/52-6/12 post MI?
  • tried/licensed beta-blocker in HF: Carvedilol, Bisoprolol, Nebivolol
  • ?Ivabradine (sinus node inhibitor via I(f) channel): eg in chron stable angina, ?also for HF
  • Aliskiren (renin inhibitor): added hypertensive, but also ?for HF (ALOFT trial underway)
  • NYHA I-IV: I=no limitation, II=comfortable at rest, ordinary activity

Neurocardiogenic/Neurally Mediated/Vasovagal syncope [NCS/NMS]

Clin Med (CME)

Ix & Tx of Hypertrophic cardiomyopathyAntiplatelet Tx in ACSFuture of CHD prevention,
ICDs, Drug Eluting Stents: Update

Acute cardiovasculare medicine,