ACUTE CORONARY SYNDROME-MANAGEMENT (C. STEMI OR NEW LBBB)

SUMMARY

1. Emergency! Admit to CCU for monitoring. If blood flow is not restored, MI will progress over the next 6 to 12 hours.

2. For all patients, give: Aspirin 300 mg orally, chewed or dissolved before swallowing, for the first dose, then 100 to 150 mg daily.

3. For a patient undergoing percutaneous coronary intervention (PCI), give with Aspirin: Clopidogrel 600 mg orally, for the first dose, then 75 mg daily OR Ticagrelor 180 mg orally, for the first dose, then 90 mg twice daily (do not use in 2nd/3rd degree AV block).

4. For a patient with very high or high acute risk of mortality & recurrent cardiovascular events: concurrently anticoagulate with LMWH or UFH.

5. For a patient receiving fibrinolytic therapy, give with Aspirin: Clopidogrel 300 mg orally, for the first dose, then 75 mg daily.

6. For a patient with significant ST elevation or new LBBB, use reperfusion (with PCI or fibrinolytic therapy) if symptoms consistent with MI started ≤ 12 hours.

7. For a patient presenting > 12 hours after symptom onset, consider reperfusion therapy in: continuing ischaemia (persistent pain), viable myocardium (preservation of R waves in infarct-related ECG leads), major complications (eg cardiogenic shock).

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].