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.
,MD,Phd
E.
.


1945

1)
2)

3)

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( )
( )
???

(, )

LBBB

Brugada

NSTEMI (Non ST Elevated Myocardial Infraction)
STEMI (ST Elevated Myocardial Infraction)

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,,
, ,

()




Vwf , Gp Ia,IIa


.

ST

ST / T

NSTEMI

STEMI

--
- --
3

20





>70%

) .
(
) .

ST
ST
MH E ST

TTS PER OS -SPRAY



2.
-


(Prinzmetal)



(,)

ST >1mm 2

R
12
non-STEMI.
5% TO HK
85% ( )
HOLTER

BLOCKER



20


,
.



IV( 10g/min,

(
1mg/kg x 2 )
CLOPIDOGREL 300mg
Aspirin
B-blocker


:
,

.
:
ST
ST:
ST



>1
o
o

NSTEMI

&

ST +/

 ST
NON ST
,

ST
,

.




,,

12 .
CK,CK-MB,TROPONINE




( -)

GPp IIb-IIa (
GPp IIbIIa )


5000 U BOLUS IV 32000 U/24



IV BOLUS 3000 IU
100 IU/kg x 2
2-8

 NSTEMI

Aspirin

4 8 lt/min 2 <90 %
(
< 90 mm Hg
160 325 mg
75 100 mg
( )
300 mg ( 600 mg
) 75 mg

60 70 IU/Kg (max 5000 IU)
] 12 15 mg/Kg (max 1000 IU/h) aPTT 1,5 2,5

Fontaparinux
(Arixtra) 2.5 mg/
Enoxaparin
(Clexane)1 mg/Kg
Dalteparin
(Fragmin) 120 IU/Kg
Nadroparine
(Fraxiparine) 86 IU/Kg
Bivalirudine
0.1 mg/Kg Bolus 0,25 mg/Kg/h

3 5 mg
PO

0.5 1 mg

STEMI

ST LBBB


ST

ST
Q (
)

STEMI

>1h

,
.
15 min
.



cTn T cTn I
CPK CK-MB

GFR CrCl
BNP ( )

SGOT

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,
, > 30%


(
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LOCAIN
.

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1
-


ST




- ST

Q KAI AN ,

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1-2 : ST, R,
Q
1-2 : T, Q
1: ST ,

2-3 : ,
Q



R V1 KAI V2
RBBB



( II,III,AVF) KAI (R V1,V2)



(,AVL,V5,V6) KAI (R V1,V2)

 LBBB

 RBBB

V1-V4
V2-V4

V4-V6,I,AVL

V1-V6,(I,AVL?)

,AVL

,,AVF

,,AVF,V5,V6

CK-MB 2-4
14-18
8-12-24-48

:,,
,


I :
/12-16

(CK-MB):
2-4
: 1-4

LDH/SGOT

V1-V7


1.
2.
3.
4.
5.
6.
7.
8.

()

325mg
Y (
5 mg)

2-4mg IV
()

02

++

.Ca

+++

++

+++

++

-/+

++
-/0
0






.


.

 () 150-300mg
300 mg 75
mg
-


( )

12
:
- ST 1mm 2

- LBBB
-:

12 (12-24 )

( ST)

6

//

6

1
(>180 mmHg / >110 mmHg)


( Streptase )

1.500.000.U 30-60min

(tPA)
( Actilyse)

15 mg IV bolus :
0,75mg/kg 30 min
O,5mg/kg 60 min

(rPA)
( Rapilysin)

10U IV bolus 2 min

30
min

(TNK-tPA)
( Metalyse)

IV bolus :
30mg <60kg
35mg :60-70kg
40mg :70-80kg
45mg :80-90kg
50mg 90kg



1.
2.

3.
4.
5.

6.

7.

(
, ,
)

40%



(20% )
(10%)


(door to
balloon time): 90
(door to needle
time): 30
>60

 -PCI


(stents)


.

12

 (< 72 )

ST

(GFR < 60 ml/min/1.73m2)
(LVEF < 40 %)

PCI 6
CABG

1
Dressler

100mg x1, - x2,

(BMI<25Kg/m2)
LDL<110mg/dl, HDL>35mg/dl, <200mg/dl
<135mmHg <85mmHg
glu: 80-110 mg/dl HbA1c<7


50

,
2 .
140
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