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Terms in this set (19)

Metoprolol

Acute coronary syndrome is a group of conditions that can be classified based on clinical and diagnostic findings. The three conditions comprising the group of conditions (unstable angina, non-ST elevation myocardial infarction,and ST elevation myocardial infarction) present with similar signs and symptoms of chest pain, dyspnea, and diaphoresis, among others. . Medical management also includes nitrates, beta-blockers, such as metoprolol, angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, oxygen, morphine, anticoagulant therapy (heparin), antiplatelet therapy (aspirin), and HMG-CoA reductase inhibitors (atorvastatin). Supplemental oxygen should be given to maintain arterial oxygen saturation above 90%. It is not indicated in normoxic patients as it can cause vasoconstriction of the coronary arteries. Morphine has been associated with high risk of death and should be administered only for severe, persistent chest pain that is not relieved by other treatment strategies. Beta-blockers and ACE inhibitors have been shown to have the most significant impact on long-term recovery as they prevent permanent remodeling of the cardiac tissue following infarct. Aspirin (A), although part of the treatment protocol for acute coronary syndrome, serves as antiplatelet therapy during acute ischemia and does not have as significant long-term benefits compared to beta-blocker therapy. Similarly, nitroglycerin (C) is used in treating acute coronary syndrome to relieve pain associated with ischemia but does not have long-term effects. Nitrates should be used with caution in patients with right ventricular infarction or severe aortic stenosis as it can cause hypotension and hemodynamic decompensation. All patients should be started on high-intensity statin therapy (atorvastatin or rosuvastatin) within 24 hours of acute myocardial infarction to decrease further coronary artery disease events. Simvastatin (D) is a moderate intensity statin and is therefore not a first-line lipid-lowering agent following myocardial infarction. Atorvastatin is a high-intensity statin that should be prescribed to all patients after acute coronary syndrome.