RT Book, Section
A1 Higgins, John P.
A1 Ali, Asif
A1 Filsoof, David M.
SR Print(0)
ID 1173757590
T1 ACS
T2 Cardiology Clinical Questions, 2e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9781259643330
LK accesscardiology.mhmedical.com/content.aspx?aid=1173757590
RD 2024/04/24
AB Table  Graphic  Jump  Location|Download  (.pdf)|PrintThe  thrombolysis  in  myocardial  infarction  (TIMI)  risk  score  is  used  for  prognostication  and  therapeutic  decision  making  in  patients  with  Non–ST-Elevation  Acute  Coronary  Syndromes  (NSTE-ACS).HPI:  Symptoms  of  chest  pain,  dyspnea,  diaphoresis.PMH:  Coronary  artery  disease  (CAD),  prior  myocardial  infraction  (MI),  hypertension  (HTN),  hyperlipidemia,  diabetes.FH:  Premature  CAD  or  MI.SH:  Smoking,  alcohol.Labs:  Elevated  troponin  or  CKMB.ST-segment  depression  of  >0.5  mm  in  two  or  more  contiguous  ECG  leads.NSTE-ACS  =  Non–ST-Elevation  Acute  Coronary  Syndromes  (Unstable  Angina/Non–ST-Elevation  MI)PCI  =  Refer  for  Percutaneous  Coronary  Intervention.MED-TX  =  MEDical  management  =  oxygen,  aspirin,  clopidogrel/ticagrelor/prasugrel  (prasugrel  only  if  going  for  PCI),  nitroglycerine,  morphine,  metoprolol,  unfractionated  heparin,  or  enoxaparin  (see  chapter  on  initial  management  of  US/NSTEMI).GP2  B3  A  =  GlycoProtein  IIb/IIIa  (2  B3  A)  inhibitors  =  use  either  of  these:Eptifibatide:  180  mcg/kg  bolus  (maximum  20  mg)  IV  over  2  minutes,  then  2  mcg/kg/min  infusion)  (maximum  15  mg/hr)  for  up  to  72  hours.  Reduce  maintenance  dose  to  1  mcg/kg/min  if  creatinine  clearance  140/90  or  on  Rx),  DM,  Hyperlipidemia  (LDL  ≥190  mg/dL/TC  ≥240/HDL  <40/TG  ≥200),  active  smoker,  fam  Hx  premature  CAD  =  fatal/nonfatal  MI,  coronary  revascularization,  or  sudden  death  <55  years  old  [father/1st  degree  male  rel]  or  <65  years  old  [female/1st  deg  rel]}HTN,  DM,  H/lipid,  active  smoker,  FamHx  premature  CAD  =  myocardial  infarction,  coronary  revascularization,  or  sudden  death  <55  years  old  (father/1st  degree  male  rel)  or  <65  years  old  (female/1st  deg  rel)Ischemia:  ≥2  anginal  episodes  in  past  24  hoursCAD  (known  stenosis  ≥50%)Aspirin  use  in  prior  7  daysTIMI  LOW  =  TIMI  LOW  risk:  score  between  0  and  2.TIMI  MODHIGH  =  TIMI  MODerate  or  HIGH  risk:  score  between  3  and  7.NO  TIME  =  patients  with  high-risk  features  not  adequately  pretreated  with  clopidogrel  or  ticagrelor,  that  is,  NO  TIME  for  adequate  treatment  with  these  oral  agents.SRT  =  Refer  patient  for  stress  imaging  study  to  evaluate  for  inducible  ischemia.SRT-POS  =  StRess  Testing  POSitive:  imaging  study  showing  significant  reversible  ischemia,  left  ventricular  dysfunction,  ejection  fraction  <0.35,  or  other  high-risk  findings.NSTE-ACS  +  HIGHR  =  MED  +  PCINSTE-ACS  +  HIGHR  +  NOTIME  =  MED  +  GP2  B3  A  +  PCINSTE-ACS  +  TIMI  LOW  =  MED  +  SRTNSTE-ACS  +  TIMI  LOW  +  SRT-POS  =  MED  +  PCINSTE-ACS  +  TIMI  MODHIGH  =  MED  +  PCINSTE-ACS  +  TIMI  MODHIGH  +  NOTIME  =  MED  +  GP2  B3  A  +  PCIPatients  with  a  high  (5–7)  or  moderate  (3–4)  TIMI  ...