Rx Note

Introduction When primary PCI for patients with STEMI is not possible within a timely fashion , fibrinolysis is an important means of reperfusion. Indications and Contraindications Fibrinolytic Agents When fibrinolytic therapy is indicated, a fibrin-specific agent (alteplase, reteplase, or tenecteplase) is recommended over a nonfibrin-specific agent (eg, streptokinase) because of greater reperfusion success and less systemic bleeding with fibrin-specific agents. Any fibrin-specific agent is acceptable as no drug has demonstrated superiority over the others with regard to the mortality benefit. Factors affecting the choice include Risk of major bleeding Ease of administration Formulary restrictions

Introduction Acute coronary syndrome (ACS) is an acute manifestation of coronary artery disease (CAD). Patients with ACS typically experience an acute reduction in coronary blood flow most often due to a ruptured atherosclerotic plaque and subsequent formation of an intracoronary thrombus. The reduction in coronary blood flow produces myocardial ischemia and, if left untreated, may lead to myocardial infarction (MI). Signs and Symptoms The "classic" presentation of ACS is abrupt onset of substernal chest pain often described as a sensation of squeezing, heaviness, or tightness in the chest that may radiate, typically to either or both arms or shoulders (radiation to the left side is more common), the neck or the jaw. Patients with ACS may also experience diaphoresis, nausea, vomiting and dyspnoea. As many as one-third patients may present with atypical symptoms that do not include chest pain. Epigastric pian Indigestion Stabbing Pleuritic chest pain Increasing exertional d...