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Angina Inestable e Infarto Agudo de Miocardio Sin Elevaciondelsegmentost
Angina Inestable e Infarto Agudo de Miocardio Sin Elevaciondelsegmentost
INTRODUCCIÓN
DEFINICIÓN
FISIOPATOLOGÍA
DIAGNÓSTICO
TRATAMIENTO
Terapia antiisquémica
Buscan reducir la demanda de oxígeno o suplir su falencia.
Terapia Antiplaquetaria
Estos agentes disminuyen la formación y propagación del trombo intracoronario
por diversos mecanismos que bloquean la activación y agregación plaquetaria.
Trombolisis
Muchos estudios han demostrado poco beneficio en los desenlaces de los
pacientes con AI/IAMSSST (51,52,53,54) y por el contrario han mostrado
aumento en el riesgo de sangrado e infarto de miocardio. Por esto la AHA/ACC
recomienda no usar terapia fibrinolítica endovenosa en los pacientes con
AI/IAMSSST, a menos que existan indicaciones precisas, como infarto agudo
con elevación del segmento ST, bloqueo completo de rama izquierda nuevo o
presumiblemente nuevo o un infarto agudo de miocardio de cara posterior
(Recom: III NE: A).
Terapia antitrombótica
Los agentes antitrombóticos previenen la propagación del trombo por su efecto
inhibitorio sobre la actividad de la trombina y en otros componentes de la
cascada de la coagulación. La heparina no fraccionada (HNF) y las heparinas de
bajo peso molecular (HBPM) bloquean indirectamente la trombina a través del
cofactor antitrombina. Muchos anticoagulantes (Hirudina, bivaluridina) inhiben
directamente la trombina, pero estas aún no han sido aprobadas para su uso y
por lo tanto no se discutirán.
CONCLUSIONES
SÍNTOMAS SUGESTIVOS
DE SINDROME
CORONARIO AGUDO
HC Y EXAMEN FISICO EVALUACIÓN Y MANEJO INICIAL:
FOCALIZADO: - Acceso endovenoso
- Síntomas y tiempo de evolución - Oxígeno, pulsioximetría
- Factores de riesgo - ECG y monitoría electrocardiográfica
- Comorbilidades, historia familiar - Marcadores cardiacos
- Signos de falla cardiaca
Altamente Definitivo
sugestivo o SCA
definitivo SCA
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