[NSTEMI] Flashcards
ST depression
flat/inverted T waves
or normal
O2 (sats below 90%)
morphine 5-10 mg IV
+
metoclopramide 10mg IV
GTN spray/sublingual (as required)
Aspirin 300mg PO initially then 75mg/day indefinitely
+
(if indicated)
clopidogrel 300mg PO initially then 75mg/day for 12 months
raised troponin ST depression on ECG ACS when already on aspirin ACS after recent MI Transfered to for angioplasty Aspirin intolerant
Hypertensive
signs of heart failure (tachycardia, LV function less than 40%)
Asthma COPD LVF bradycardia coronary spasm
metoprolol 50mg/12hrs
Diltiazem 60-12mg/8hrs PO
Verapamil 80-120mg/8hrs PO
Fondapurinux 2.5mg OD SC daily until discharge
or LMWH/UFH
Factor Xa inhibitor
GTN 50mL in 0.9% saline at 2-10mL/h
intravenous NOT sublingual**titrated
it is titrated against pain
BP must remain >100mmHg systolic
No recurrence of chest pain No signs of heart failure Normal ECG present Normal baseline troponin 6-9-12 hours post pain No inducible ischaemia
discharge
arrange further testing (angiography)
Rise in troponin dynamic ST changes or Dynamic T wave changes 2ry criteria (inc. intermediate-high GRACE score)
DM CKD LVEF less than 40% early angina post MI recent PCI prior CABG intermediate-high GRACE score
glycoprotein IIb/IIa inhibitor (e.g. Tirofiban)
angiography within either 120mins/24hrs/72 hrs (inpatient)
doesn’t fill criteria for 120mins/24 hours
GRACE score >140
ongoing angina despite Tx
evolving ST changes
cardiogenic shock signs
life-threatening arrythmias
ACE-i
statin
dual antiplatelet therapy
b-blocker (if LV depressed function)
until discharge
when stabilised on oral drugs - wean off
troponin
serial ECG
smoking
hypertension
hyperlipidaemia
diabetes
but all of them
Global Registry of Acute Coronary Events
guides future treatment in patients with current ACS: by predicting risk of future death or MI
% chance of dying at 6months, 1yr and 3 yrs after admission
age HR BP renal function heart function biomarkers
(90% accuracy!)
U+E troponin glucose random cholesterol FBC CXR
asystole inducing
