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Related Concept Videos

Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

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Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
475
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

159
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
159
Acute Coronary Syndrome V: Nursing Management01:26

Acute Coronary Syndrome V: Nursing Management

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Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
215
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

301
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
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ST-Segment Elevation Myocardial Infarction and Out-of-Hospital Cardiac Arrest: Contemporary Management From the

Meena Zareh, Jeffrey J Rade, Joseph L Thomas

  • 1Division of Cardiovascular Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033 USA. shavelle@usc.edu.

The Journal of Invasive Cardiology
|January 17, 2020
PubMed
Summary

Primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) show high survival and good neurologic outcomes in ST-elevation myocardial infarction (STEMI) patients after out-of-hospital cardiac arrest (OHCA). This study highlights key predictors for successful recovery in these critical patients.

Keywords:
STEMIout-of-hospital cardiac arrestprimary PCItargeted temperature management

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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Area of Science:

  • Cardiology
  • Neurology
  • Emergency Medicine

Background:

  • ST-segment elevation myocardial infarction (STEMI) complicated by out-of-hospital cardiac arrest (OHCA) presents a critical clinical challenge.
  • Emerging evidence suggests primary percutaneous coronary intervention (PCI) and targeted temperature management (TTM) improve outcomes in these patients.
  • Characterizing contemporary treatment approaches and neurologic outcomes is crucial for optimizing patient care.

Purpose of the Study:

  • To evaluate treatment strategies and identify predictors of neurologic outcome in a contemporary series of STEMI patients with OHCA.
  • To assess the effectiveness of primary PCI and TTM in this high-risk patient population.
  • To determine factors associated with in-hospital survival and good neurologic function.

Main Methods:

  • A multicenter registry enrolled 239 patients with STEMI and OHCA from January 2009 to November 2012.
  • Patients underwent emergent coronary angiography and revascularization.
  • Neurologic outcome was assessed using the Cerebral Performance Category (CPC) score, with logistic regression used to identify predictors.

Main Results:

  • The study included 239 patients (mean age 60±13 years, 72% male) with STEMI and OHCA.
  • Primary PCI was performed in 74% of patients, and TTM was utilized in 51%.
  • Good neurologic function (CPC score 1 or 2) was achieved in 55% of patients, with an overall in-hospital survival rate of 66%.

Conclusions:

  • Contemporary management including emergent coronary angiography, revascularization, and TTM in STEMI patients with OHCA is associated with high short-term survival.
  • More than half of the patients experienced good neurologic outcomes, underscoring the effectiveness of current treatment protocols.
  • Bystander CPR, arrest location, drug-eluting stent use, and absence of recurrent cardiac arrest were independent predictors of survival with good neurologic function.