CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries

CRACKCast E078 - ACS Part B

17 snips
May 18, 2017
Dive into the world of acute coronary syndromes where experts break down critical criteria like Sgarbossa for diagnosing AMI and uncover the complexities of Takotsubo cardiomyopathy. Explore the kinetics of cardiac biomarkers like Troponins and learn the ins and outs of PCI versus thrombolytics. Discover the importance of timely interventions and the nuances of managing NSTEMI patients. Plus, gain insights on unique cases like cocaine-induced ACS and the role of cutting-edge tools such as the HEART score!
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ADVICE

Fibrinolytics Contraindications

  • Avoid fibrinolytics in recent surgery, trauma, uncontrolled hypertension, bleeding disorders, or stroke history.
  • Lower blood pressure if high before administration; age over 75 is no longer absolute contraindication.
INSIGHT

Rescue versus Facilitated PCI

  • Rescue PCI is for failed fibrinolysis to revascularize with persistent symptoms or ST elevation.
  • Facilitated PCI combining fibrinolysis and PCI shows no mortality benefit and is not recommended.
ADVICE

Indications for Rescue PCI

  • Indications for rescue PCI include persistent chest pain, ST elevation, cardiogenic shock, post-perfusion ischemia, or ventricular arrhythmias.
  • Do not repeat fibrinolytics if rescue PCI is planned.
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