Acute Chest Pain / ACS Assessment and Plan

[text name="variable_1" default="sample text"]yo [select name="variable_1" value="M|F"] presents with acute chest pain

ASSESSMENT/PLAN:
-12Lead ECG → If 2 contiguous leads elevated → EMERGENT Cath Lab ICA/PCI
--If ECG (-) → Troponin → If elevated → URGENT Lab ICA/PCI
---If ECG/Initial Trop (-) → serial ECG and trops w/ stress/CCTA in AM

Med Management: MONA BASH2
-ASA: 325mg
-BB: To prevent fatal arrythmia
-Nitro: MOA-Reduces preload → DON'T use with inferior (II/III/aVF) infarction. W/ PDE5 inh. can drop BP too much. HAs should subside after med wears off.
-Heparin: To prevent DVT. Give Heparin infusion if PCI. Give LMWH if no PCI
-Clopidogrel: Give 300mg if ACS diagnosed or if ruling in. 75mg thereafter. Improves revascularization outcomes
-ARB/ACE: To reduce infarct size and prevent EF loss
-Statin: Atorvastatin 40/80mg OR Rosuvastatin 20/40mg
-Morphine: For refractory pain
-Oxygen: Get pulse ox to normal. Don't overdo it!

Complications to Watch for post ACS:
-Anytime: Cardiogenic  Shock
-24hrs: Ventricular Arrythmia (Admit telemetry, give BB)
-72hrs: Acute Pericarditis
-5th Day: Rupture of...
--Free Wall → Pericardial Tamponade
--Septum → VSD
--Papillary Muscle → Murmur w/ HF
-28th Day: Autoimmune Pericarditis AKA Dressler Syndrome (Tx: NSAIDS→Colchicine→Steroids (LAST))
-28+ Days: Ventricular Aneurysm and Thrombus (Dx: Echo, Tx thrombus w/ anticoag)