tx stemi ACS gen

1. cardiogenic shock tx complicated MI

1.1. extensive LV infarct -> pump failure

1.2. immediate vascularization (CABG)

1.3. medical stabilization

2. low output state tx comp MI

2.1. order echo

2.2. start dobutamine +/- vasodilators (reduced afterload)

3. pulmonary edema tx com MI

3.1. MONA +/- loop diuretics

4. longterm tx (secondary prevention)

4.1. ace inhibitors

4.2. beta blockers

4.3. antiplatlet agents

4.4. hypolipedemics (statins)

5. tx complicated MI hypotention

5.1. fluids; vasopressors

5.2. vasopressors: increase PVR and BP

5.2.1. dopamine:

5.2.1.1. low dose: dilate renal and coronary arteries

5.2.1.2. high dose: stimulates alpha1/beta1 receptors-> vasoconstriction and increased contractility

5.2.2. norepeinephrine

5.2.2.1. postent vasoconstrictor for severe HTN

6. arrhythmias

6.1. VF and pulsless VT: shock->epi-> lido/amioderone

6.2. polymorphic vtach: shock

6.3. sustained monomorphic VT w/ symptoms-> 100J initial shock

6.4. sustained VT w/o symptoms -> amiodarone