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Hot Topics

Hot Topics

Updates to Guidelines and Recommendations

Q: Are IV beta blockers useful in the treatment of STEMI?

IV beta blockers were downgraded in the most recent updates on acute MI care for both STEMI and NON-STEMI. They were formerly class I recommendations  (definitely recommended) and are now class II ( acceptable and useful) . The use of oral beta blockers is a class I recommendation (definitely recommended) for both STEMI and NONSTEMI.

Q: Are there any changes for the ACLS treatment of ventricular arrhythmias?

Procainamide for the treatment of ventricular tachycardia has been reintroduced into the treatment pathway.

Q: Have there been changes in treatment recommendations for diabetes management in patients with acute MI?

Procainamide for the treatment of ventricular tachycardia has been reintroduced into the treatment pathway.

Q: Does cardiac rehab remain a part of post MI care?

Cardiac rehab is a critical part of the care plan for AMI patients. Patients that complete cardiac rehab post MI have fewer recurrent events, greater survival and better functional status compared to those who do not go on to rehab. This is true for patients with all types of MI and all heart failure classifications for post MI patients.

Q: The A-B-C-s (Airway-Breathing-Compression) of CPR was rearranged to C-A-B (Compressions-Airway-Breathing).

Q: “What about smokeless tobacco?”

“As a national nonprofit health organization committed to
promoting tobacco control research and policy efforts, the
American Heart Association does not recommend the use of
‘Spit Tobacco’ as an alternative to cigarette smoking or as a smoking
cessation product……… clinicians should continue
to discourage use of all tobacco products and emphasize
the prevention of smoking initiation and smoking cessation as
primary goals for tobacco control.”

Current Clinical Challenges

Q: Do thrombolytic patients require heparin?

All thrombolytics that are plasminogen activator type agents used for acute MI require the use of an antithrombin drug such as heparin and low molecular weight heparin.

Q: What if a patient is allergic to heparin or has a history of HIT (Heparin-induced Thrombocytopenia ) syndrome?

Low molecular weight heparin is not a safe alternative in this patient group. However, agents such as bivalrudin and fondaparanux are safe and effective. The use of these agents remains pivotal in treatment of both STEMI patients receiving thrombolytic therapy and in patients with NONSTEMI or unstable angina

Q: What are some of the most common reasons for readmission after acute MI?

Medication noncompliance, poor understanding of discharge instruction, congestive heart failure and chest pain remain the most common reasons. It is imperative that patients with AMI have early follow-up after discharge, best within 3-5 days, for medication reconciliation and review of activity instructions. Be aware of patients at highest risk for heart failure (older patients, anterior infarctions, patients with bypass at the time of infarction, and those with mechanical complications of infarction such as ischemic mitral regurgitation).

Q: What is the role of ASA in secondary prevention?

Aspirin for secondary prevention of cardiovascular events and for post PCI care remains a class I (definitely recommended) indication for both men and women.
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