1. - Myocardial Infarction Can be Diagnosed with chest pain, and "ST" elevation, OR increased Cardiac enzymes. - pt. w/ no risk factors of CAD should not be on Aspirin only because of their age, or gender. -Thienopyridines are a class of ADP receptor/P2Y12 inhibitors Ticlopidine (Ticlid), OR Clopidogrel (Plavix) is added to Aspirin only if pt. has a stroke, or if the pt. will be undergoing a percutaneous coronary intervention; it can be used instead of Aspirin if the patient is allergic to aspirin. - Pt. can have sex after MI if any of the following is present: - pt. can climb 2 flights of stairs, - if 6 weeks pass since the MI is controlled. - Do not use Viagra until 6 hours pass after the pt. takes any nitrate medication
2. Cardiac Cath. if pt. had a positive stress test
   1. 1 or 2 vessels involved
      1. Rx. Stent
   2. 2 vessels with D.M
   3. 3 or more vessels
      1. Rx. CABG surgery
   4. Left Main coronary Artery
3. 1st : - Transport to ER, & keep NPO for possible cath. - focused P/E of HEENT/ Neck, CVS, Respiratory, Abdomin, and r/o DVT via Musculoskeletal exam - Inv. : pulse oximeter, IV access, cardiac monitor, BP monitor, Urine output monitor, Troponin-I, & 12 lead EKG - Rx: - DECREASE MORTALITY by Rx. Aspirin(PO) - palliative Rx. O2 inhilation, sublingual-Nitroglycerin, & Morphine(IV)
   1. 2nd : Look at the EKG
      1. "ST" elevation of at least 1mm in at least 2 leads OR a new Left Bundle Branch Block
         1. Troponin high
            1. Dx. Myocardial INFARCTION
            2. 3ed : Rx. Angioplasty is better then t-PA (IV)
            3. if chest pain is not improving Rx. glycoprotein IIb/IIIa inhibitors abciximab(IV) or tirofiban(IV)
            4. 4th : - Move to the ICU, keep NPO, Keep on NS Fluids, and Keep all monitors;
            5. 5th: DECREASE MORTALITY by giving the following Rx: -Give a Beta blocker eg: Metaprolol(IV), then discharge on (PO) -Give I. ACE Inhibitor(eg Captopril (PO), II. Angiotensin II receptor blockers (ARBs) losartan(PO), stop the drug once ejection fraction is normal - Start a statin drug like simvastatin(PO) if LDL is more then 100
            6. 5 days after monitoring, and improvement, start investigating the number of coronary vessels affected depending on the pt Hx.
            7. Hx. CAD
            8. Inv. Stress Echo-Cardiology
            9. No Hx. of any CVS disease
            10. Inv. Sterss- EKG
            11. Hx. Any disease preventing exercise, (eg: arthritis)
            12. Inv. Myocardial Perfusion imaging
      2. "ST" depression
         1. "T" wave inversion
            1. Troponin high
            2. Dx. Non "Q" wave INFARCTION
            3. Troponin low
            4. Dx. Unstable Angina (ISCHEMIA)
            5. 3ed : Rx. Low Molecular Weight Heparin(SC) do a rectal exam to r/o fecal occult blood before starting heparin