Cardiology: ACS

Question 1

How to manage STEMI in ED

including who goes for PCI

Answer 1

300mg Aspirin ((if definitely not dissection))
Oxygen, GTN and Morphine if needed

PCI:
If presenting within 12 hours and PCI can be performed within 2 hours
Of if presenting at more than 12 hours but with ongoing pain or cardiogenic shock
Check local policy to see if we give anything else before sending for PCI

Consider Fibrinolysis if primary PCI not available but still presenting within 12 hours

For those not suitable for PCI:
Add Ticagrelor or Clopidogrel to Aspirin
- Generally use Ticagrelor
- Use Clopi if high bleeding risk. Or consider using Aspirin alone

Question 2

How to manage NSTEMI/Unstable angina in ED

Answer 2

Oxygen
Morhphine
GTN
Aspirin 300mg (if definitely not dissection)

Fondaparinux in most cases (generally 2.5mg)
Consider unfractionated heparin in renal failure (Creat >265)

The medics will use scoring tool such as GRACE to establish CV risk and decide on next steps
- Immediate angiography vs conservative management