The Curbsiders Internal Medicine Podcast #451 Acute Coronary Syndrome with Dr. Sanjeev Francis - Part 2
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Sep 2, 2024 
In this enlightening discussion, Dr. Sanjeev Francis, a cardiologist from Maine Medical Center, dives deep into acute coronary syndrome management. He explains the nuances of stress test warranties and how to tackle elevated troponins in septic patients. The conversation also covers risk stratification, the intricacies of diagnosing myocardial injury, and approaches to non-ST elevation ACS. Through real-life case studies, listeners gain valuable insights on treatment protocols and the importance of patient communication in cardiac care.
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Managing Anticoagulation in ACS with Pre-existing AC
- Stop warfarin or DOACs in ACS patients requiring catheterization.
- Bridge with IV heparin after the DOAC's effect diminishes or when INR is subtherapeutic.
Oxygen, Morphine, and Beta-blocker Use in ACS
- Use supplemental oxygen in ACS only if O2 saturation is below 90%.
- Morphine can alleviate pain, but its use suggests higher risk, while beta-blockers effectively reduce myocardial workload.
Pre-Catheterization Patient Counseling
- When discussing catheterization with patients, outline three potential outcomes: bypass surgery, stent placement, or medical management.
- Explain that catheterization helps determine the best treatment approach.