Episode 75 – Door to Balloon and in Between w/Dr. Adam Gottula & Dr. Trevor Skrobut

 

Managing Acute Myocardial Infarction (AMI) patients is a concept that many of us learn early on in our careers. Because of that, we can potentially underestimate the importance of our interventions.

In this podcast episode, we are joined by Dr. Gottula and Dr. Skrobut to discuss timely management of AMI’s, when coronary intervention (PCI) is indicated, and what medications we should consider to achieve maximal medical management of a patient suffering an AMI in 2021.

 

Includes:

  • Aspirin
  • Anticoagulant
  • P2Y12 inhibitor
  • Analgesia
  • Statin
  • Normoxia
  • Normokalemia
  • Anticipate and Prepare

 


Guests

Adam Gottula, MD is an Anesthesia Critical Care Fellow at The University of Michigan with an interest in critical care, cardiac mechanical support, and HEMS. He is a graduate of the University of Cincinnati Department of Emergency Medicine and former Resident Assistant Medical Director for UC Health Air Care & Mobile Care.

 

Trevor Skrobut, MD is an Emergency Medicine Physician working in Northern Kentucky and Eastern Indiana and a former flight physician with Air Care. His specific area of interest is optimization of ED based resuscitation. In his free time, he enjoys hiking with his dog, snowboarding with his wife, and has recently picked up tour biking. He is a graduate of the University of Cincinnati Department of Emergency Medicine and former Resident Assistant Medical Director for UC Health Air Care & Mobile Care.


Abuzaid A, Fabrizio C, Felpel K, et al. Oxygen therapy in patients with acute myocardial infarction: a systematic review and meta-analysis. Am J Med. 2018;131:693.

Amsterdam EA, Wenger NK, Brindis RG, Casey Jr DE, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes. Circulation. 2014;130:e344-e426.

Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev 2010;6:CD007160.

Callaway CW, Donnino MW, Fink EL, et al. 2015 Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S465-82.

Efficacy of High-Dose Atorvastatin Loading Before Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction The STATIN STEMI Trial

Farag M, Spinthakis N, Srinivasan M, Sullivan K, Wellsted D, Gorog DA. Morphine Analgesia Pre-PPCI Is Associated with Prothrombotic State, Reduced Spontaneous Reperfusion and Greater Infarct Size. Thromb Haemost. 2018;118(3):601–612. doi:10.1055/s-0038-1629896

Farquhar H, Weatherall M, Wijesinghe M, et al. Systematic review of studies of the effect of hyperoxia on coronary blood flow. Am Heart J 2009;158:371-7.

Go, Alan S., Dariush Mozaffarian, Véronique L. Roger, Emelia J. Benjamin, Jarett D. Berry, Michael J. Blaha, Shifan Dai, et al. 2014. “Heart Disease and Stroke Statistics–2014 Update: A Report from the American Heart Association.” Circulation 129 (3): e28–292.

Hobl EL, Stimpfl T, Ebner J, et al. Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial [published correction appears in J Am Coll Cardiol. 2018 Aug 7;72(6):705]. J Am Coll Cardiol. 2014;63(7):630–635. doi

McNulty PH, Robertson BJ, Tulli MA, et al. Effect of hyperoxia and vitamin C on coronary blood flow in patients with ischemic heart disease. J Appl Physiol 2007;102:2040-5.

Parodi G, Bellandi B, Xanthopoulou I, et al. Morphine is associated with a delayed activity of oral antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Circ Cardiovasc Interv. 2014;8(1):e001593. Published 2014 Dec 31. doi:10.1161/CIRCINTERVENTIONS.114.001593

Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2(8607):349–360

Rathore SS, Curtis JP, Chen J, et al. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ. 2009;338:b1807. Published 2009 May 19. doi:10.1136/bmj.b1807

Roff iM, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). EurHeart J 2016;37:267-315.

Schneider MA, McMullan JT, Lindsell CJ, Hart KW, Deimling D, Jump D, Davis T, Hinckley WR. Reducing Door-in Door-out Intervals in Helicopter ST-segment Elevation Myocardial Infarction Interhospital Transfers. Air Med J. 2017 Sep-Oct;36(5):244-247. doi: 10.1016/j.amj.2017.04.004. Epub 2017 Jun 24. PMID: 28886785.

Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM. Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 2015;131:2143–2150.

Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD: the Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138:e618–e651. DOI: 10.1161/CIR.0000000000000617.

 Tomaszewski CA, Nestler D, Shah KH, Sudhir A, Brown MD. Clinical policy: Critical issues in the evaluation and management of emergency department patients with suspected non-ST-elevation acute coronary syndromes. Annals of Emergency Medicine. 2018;72,e65.

One thought on “Episode 75 – Door to Balloon and in Between w/Dr. Adam Gottula & Dr. Trevor Skrobut

Comments are closed.

Up ↑