Clinical questions pt. 6?

[GravityBeetle]

I have a new set of questions for you guys

1. In NSTEMI, are there situations when you would not do DAPT? And if you do, when do you start Plavix? Immediately upon presentation or after stopping anticoagulant (eg heparin drip)? I've seen some cardiologist recommend only ASA alone. I've also seen Plavix being started much later after anticoag was stopped. Guidelines recommend adding a P2Y12 inhibitor to all patients with NSTE-ACS. Also is chest pain necessary for a NSTEMI diagnosis or only elevated cardiac markers? What if there was no chest pain but other symptoms (eg syncope)?
2. What's the difference between ischemic cardiomyopathy vs HF?
3. What's your take on SC or IM vitamin K? Package insert recommends against IV – says SC preferred... Lexicomp/MMX has no data on SC PK and for IM only says "readily absorbed". Many now recommend against SC due to unpredictable absorption. What is onset of SC vs PO/IM? Would giving 10 mg SC or more ensure that an adequate amount is absorbed?
4. When following AHA guidelines does higher Level of Evidence direct you to what's first, second, third line, etc (assuming same Class of Recommendation)? For example per ACCF/AHA STEMI guidelines, in addition to fibrinolytic, would you consider enoxparin 1st line, fondaparinux 2nd line, and heparin 3rd line (assuming all else being equal) given that their LOE are A,B, and C respectively?
5. Any guidelines on what can/can't be given via NG tube? Can any PO liquid or PO meds that can be crushed go in?

Thanks!

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