Acute Coronary Syndrome—Without ST-Elevation

Question 1

Acute Mx of ACS without ST-segment elevation:

Answer 1

1. Admit to CCU and monitor closely
2. If SaO2 <90% or breathless, low flow O2
3. Analgesia - Morphine 5–10mg IV + metoclopramide 10mg IV
4. Nitrates: GTN spray or S/L tablets PRN
5. ASA 300mg PO and 2nd antiplatelet agent (clopidogrel, ticagrelor, prasugrel) unless CI
6. Oral B-blocker: eg metoprolol 50mg/12h if HPT/ tachycardic/ LV function < 40%
   **7. If B-blocker contradicted (asthma, COPD, LVF, bradycardia, coronary spasm), give rate-limiting CCB - verapamil1 80–120mg/8h
7. Fondaparinux 2.5mg OD SC or LMWH 1mg/kg/12h SC
8. IV nitrate if pain continues give infusion - GTN 50mg in 50mL 0.9% saline at 2–10mL/h**