PHARMACOLOGY ( PRETREATMENT ) IN STEMI

IOANNIS N. VLASSEROS

CARDIOLOGICAL DEPARTMENT HIPPOKRATION HOSPITAL OF ATHENS

HISTORY: Patient 78 years old was transferred in CH Karystou

because precordial pain with nausea and sweating. In CH Karystou found anterior STEMI and he was

underwent in thrombolysis (Metalyse) so that the elevation fell and changed to idioventricular rhythm.

He was transferred to our hospital to for coronary angiography and possible PCI

The patient was asymptomatic.Individual memonto:

Non-Q myocardial infarction inferior wall before 8 years PCI (mouth stenosis 85% in medial branch).Risk factors: smoking (+), alcohol (-), HP (+), dyslipidemia (-), heredity (-), diabetis (-). allergies: (-).

Laboratory findings

TnImax:253 ,Ht : 39,6%, WBC 7200/uL, PLT 197000/uL, κρεατινίνη 0,9 mg/dl, ουρία 24mg/dl, K 4,2 meq/L, Na 135 meq/L, CPK 1980 IU/L CK-MB 36 IU/L, LDH 459U/L , SGOT 189 IU/L, SGPT 38 IU/L

Echo:LVEF=30-35%,apical akinisis MR ¼, PASP=30 mmhg

8/12/11 ,13.38µµ

8/12/11,15.15

8/12/11,18.40

Pharmagology

Clopidogrel (plavix 75mg) 1x1,Aspirine(salospir 100mg 1x1 N / L iv,and peros)PPi's (controloc 40 mg) 1 x1

ACEi (Coversyl 5mg): 1/2x1,Atorvastatin (Lipitor mg 10 )1x1Enoxaparine (Clexane 60) 1x2GPIIb /IIIa antagonism (Aggrastat )10 ml/h

What do you do

A:PCI B:CABG C:Conservatively

Pharmacology In view of the likelihood of surgical treatment was

interruptedClopidogrel (plavix)

Aspirin(salospir) and was continued administration Tirofiban (Aggrastat)

In the second time was decided to attempt to PCI and given a loading dose ofClopidogrel (Plavix) 300mgAspirine (salospir) 325mg

and he was underwent in angioplasty of the lesion.

12/12/11,after PCI

MERRY CHRISTMAS