1. Anti-angina treatment guidelines recommend bed rest, oxygen supplementation, and pain relief medications like nitrates for acute angina.
2. For stable angina, long-acting nitrates, beta-blockers, or calcium channel blockers are recommended as prophylaxis.
3. For unstable angina, American Heart Association guidelines recommend antiplatelet therapy like aspirin, clopidogrel, and IV GP IIb/IIIa inhibitors to relieve pain and prevent heart attack progression.
EVALUATION OF THE INFLUENCE OF TWO DIFFERENT SYSTEMS OF ANALGESIA AND THE NASOGASTRIC TUBE ON THE INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING IN CARDIAC SURGERY
1. Anti-angina treatment guidelines recommend bed rest, oxygen supplementation, and pain relief medications like nitrates for acute angina.
2. For stable angina, long-acting nitrates, beta-blockers, or calcium channel blockers are recommended as prophylaxis.
3. For unstable angina, American Heart Association guidelines recommend antiplatelet therapy like aspirin, clopidogrel, and IV GP IIb/IIIa inhibitors to relieve pain and prevent heart attack progression.
1. Anti-angina treatment guidelines recommend bed rest, oxygen supplementation, and pain relief medications like nitrates for acute angina.
2. For stable angina, long-acting nitrates, beta-blockers, or calcium channel blockers are recommended as prophylaxis.
3. For unstable angina, American Heart Association guidelines recommend antiplatelet therapy like aspirin, clopidogrel, and IV GP IIb/IIIa inhibitors to relieve pain and prevent heart attack progression.
1. Anti-angina treatment guidelines recommend bed rest, oxygen supplementation, and pain relief medications like nitrates for acute angina.
2. For stable angina, long-acting nitrates, beta-blockers, or calcium channel blockers are recommended as prophylaxis.
3. For unstable angina, American Heart Association guidelines recommend antiplatelet therapy like aspirin, clopidogrel, and IV GP IIb/IIIa inhibitors to relieve pain and prevent heart attack progression.
Pathophysiology • Angina pectoris Symptom, not disease • Paroxismal pain in the chest (esp. in pectoral region) that is generated by episodes of ischemia in ventricular myocardium. Pathophysiology • Myocardial ischemia can result from: – fixed partial obstruction of an artery/ arteries due to atheroma or other pathologic process – Inaproppriate arterial vasospasm – A trombus Types of angina • angina pectoris : imbalance blood supply and myocard demand. Precipitated and/ worsened by exercise, stress etc • Chronic stable angina: caused by fixed coronary stenosis • Unstable angina: occur at rest or with physical exercise, has a crescendo pattern • Varian angina (Printzmetal): caused by coronary vasospasm General guideline Of Angina’s Treatment Acute • Sublingual nitrat angina Stable • Used as prophylaxis • Long acting nitrates • B2 selective blocker angina • Ca 2+ channel blocker
Unstable • Relieving pain, peventing progression of AMI
• Lihat AHA guideline for Unstable angina and NSTEMI angina • http://www.onlinejacc.org/content/50/7/652 AHA guideline for Unstable angina and NSTEMI • Class I: tdp bukti dan/ general agreement bahwa efektif dan bermanfaat • Class II: tdp bbrp bukti yang bertentangan dan/ pendapat bahwa bermanfaat • Class III: tdp bukti dan/ general agreement bahwa tdk bermanfaat bahkan dpt harmful Class I: analgesic and anti-ischemic • 1. Bed/chair rest with continuous ECG monitoring is recommended for all UA/NSTEMI patients during the early hospital phase. (Level of Evidence: C) • 2. Supplemental oxygen should be administered to patients with UA/NSTEMI with an arterial saturation less than 90%, respiratory distress, or other high- Class I : Antiplatelet therapy • 1. Aspirin should be administered to UA/NSTEMI patients as soon as possible after hospital presentation and continued indefinitely in patients not known to be intolerant of that medication. (Level of Evidence: A)(Figs. 6 and 7; Box A) • 2. Clopidogrel (loading dose followed by daily maintenance dose)†should be administered to UA/NSTEMI patients who are unable to take ASA because of hypersensitivity or major gastrointestinal intolerance. (Level of Evidence: A)(Figs. 6 and 7; Box A) • 3. In UA/NSTEMI patients with a history of gastrointestinal bleeding, when ASA and clopidogrel are administered alone or in combination, drugs to minimize the risk of recurrent gastrointestinal bleeding (e.g., proton-pump inhibitors) should be prescribed concomitantly. (Level of Evidence: B) Class I : Antiplatelet therapy • 4. For UA/NSTEMI patients in whom an initial invasive strategy is selected, antiplatelet therapy in addition to aspirin should be initiated before diagnostic angiography (upstream) with either clopidogrel (loading dose followed by daily maintenance dose)†or an IV GP IIb/IIIa inhibitor. (Level of Evidence: A)Abciximab as the choice for upstream GP IIb/IIIa therapy is indicated only if there is no appreciable delay to angiography and PCI is likely to be performed; otherwise, IV eptifibatide or tirofiban is the preferred choice of GP IIb/IIIa inhibitor. (Level of Evidence: B) • 5. For UA/NSTEMI patients in whom an initial conservative (i.e., noninvasive) strategy is selected (see Section IV.C), clopidogrel (loading dose followed by daily maintenance dose)†should be added to ASA and anticoagulant therapy as soon as possible after admission and administered for at least 1 month (Level of Evidence: A)and ideally up to 1 year. (Level of Evidence: B)(Fig. 7; Box C2) Class I : Antiplatelet therapy • 6. For UA/NSTEMI patients in whom an initial conservative strategy is selected, if recurrent symptoms/ischemia, HF, or serious arrhythmias subsequently appear, then diagnostic angiography should be performed (Level of Evidence: A)(Fig. 7; Box D). Either an IV GP IIb/IIIa inhibitor (eptifibatide or tirofiban; Level of Evidence: A) or clopidogrel (loading dose followed by daily maintenance dose; Level of Evidence: A)†should be added to ASA and anticoagulant therapy before diagnostic angiography (upstream). (Level of Evidence: C)
EVALUATION OF THE INFLUENCE OF TWO DIFFERENT SYSTEMS OF ANALGESIA AND THE NASOGASTRIC TUBE ON THE INCIDENCE OF POSTOPERATIVE NAUSEA AND VOMITING IN CARDIAC SURGERY