ACUTE CORONARY SYNDROME-MANAGEMENT (B. IN-HOSPITAL)
SUMMARY
GENERAL MANAGEMENT FOR ALL ACS (STEMI & NSTEACS)
1. Continuous ECG monitoring in CCU
ANTI-PLATELET AGENTS
2. Aspirin +/- Clopidogrel (mainstay of management)
SYMPTOM MANAGEMENT
3. S/L GTN x3/PRN for pain and IV NTG for continued ischemia or hypertension
4. Morphine if pain is not relieved by NTG
MEDICAL MANAGEMENT
5. Stop all NSAIDs
6. High-dose statin
7. Beta-blockers (if LVEF < 40% or prior MI). Use Carvedilol, Metoprolol, Bisoprolol. CI in bradycardia, hypotension, 2/3o AV block, pulmonary oedema, acute HF, asthma
8. ACE inhibitors (if LVEF < 40%, DM, HTN, or CKD)
9. Good blood sugar control
SUMMARY (8 drugs): Aspirin +/- Plavix, GTN, oxygen, fentanyl/morphine, statins, beta-blockers, ACE-inhibitors
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
