#ᑕᗩᖇᗪIOᒪOGY_82 #ACS_10 #STEMI البوست الأخير في ال STEMI | Clinical Medicine

#ᑕᗩᖇᗪIOᒪOGY_82 #ACS_10 #STEMI

البوست الأخير في ال STEMI

Other Medications for STEMI Pt ;

Beta Blocker :

حسب ال American Guidelines أول 24 ساعه لازم المريض يبدأ BB ويستمر عليه ما لم يكن Contraindicated ..

Metoprolol tartrate 25 to 50 mg every 6 to 12 h orally, then transition over next 2 to 3 d to twice-daily dosing of metoprolol tartrate or to daily metoprolol succinate; titrate to daily dose of 200

Carvedilol 6.25 mg twice daily, titrate to 25 mg twice daily as tolerated

ال BB ممكن يتاخد I.V في حالات ال hypertensive or ongoing ischemia

Metoprolol tartrate IV 5 mg every 5 min as tolerated upto 3 doses; titrate to heart rate and BP

BB contraindication ( heart failure, low output state, hypotension, bradycardia, heart block, STEMI precipitated by cocaine use )


ESC : recommend BB oral therapy for patients with STEMI with heart failure and/or left ventricular ejection fraction (LVEF) ≤ 40% (ESC Class I, Level A)



ACEIs /ARBs

For patients with anterior infarction, post-MI LV systolic dysfunction (EF ≤0.40) or HF
( class 1 Recommendation )

• May be given routinely to all patients without contraindication ( class 2a Recommendation )

Lisinopril 2.5 to 5 mg/d to start; titrate to 10 mg/d or higher as tolerated

Captopril 6.25 to 12.5 mg 3 times/d to start; titrate to 25 to 50 mg 3 times/d as tolerated


Ramipril 2.5 mg twice daily to start; titrate to5 mg twice daily as tolerated

Trandolapril test dose 0.5 mg; titrate up to 4 mg daily as tolerated

لو المريض كان Intolerated لل ACEIs مثلا صار عنده dry cough
فبيتشفت ل ARBs
Valsartan 20 mg twice daily to start; titrate to 160 mg twice daily as tolerated



Aldosterone antagonists :

recommended unless contraindicated for patients

with STEMI, LVEF < 40%, either symptomatic heart failure or diabetes mellitus, and already receiving ACE inhibitor and beta-blocker (ACCF/AHA Class I, Level B; ESC Class I, Level B)


High-intensity statin

recommended for all patients with STEMI and no contraindications (ACCF/AHA Class I, Level B; ESC Class I, Level A);
statin use within first 24 hours associated with lower in-hospital mortality and fewer early complications

R/Atorvastatin 40-80 mg od or Rosuvastatin 20-40 mg od


R/Isosorbide mononitrate (od for SR tablets, or bid for short acting tablets with 8h interval in between).
لو لسه المريض ضايل عنده Chest pain فبياخد Nitrate ..

هيك بنكون خلصنا ال STEMI بفضل رب العالمين
#لعلي_أفيدك