A 69-year-old female with diabetes, HTN, high cholesterol, previous angina with stents placed 8 months ago presents for central, non-radiating chest pain with belching and shortness of breath. The pain began while watching the finale of the Bachelor this week. The patient endorses that she has not taken any of her medications for the past month because she has been feeling well and did not think that she needed them anymore. Physical exam shows an elevated blood pressure 162/96, other vital signs within normal limits.The rest of the physicial exam was significant only for trace pedal edema and obesity. An ECG shows new ST depressions in the lateral heart leads. Laboratory information is pending.
What medication has the greatest impact on MORTALITY for patients presenting with this condition?Answer
ASPIRIN! The NNT for aspirin to prevent one death from acute coronary ischemia is 42. The ISIS-2 trial showed that there was 23% decreased mortality in patients who received aspirin (and not thrombolytics). For patient’s who received aspirin AND thrombolytics, there was shown to be synergistic effect, with 42% reduction in mortality. Bottom line: if coronary ischemia is on the differential, and there are no real contraindications (aortic dissection, allergy with bronchospasm) then give it. Ya hear?
Rosen’s 7th Edition.
By: Sally Bogoch and Andy Grock
sbogoch
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