Acute Coronary Syndrome

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Anti-Ischemic Therapy I IIa IIb III Major Change Oral beta-blocker blocker therapy should be initiated within the first 24 h for patients who do not have 1 or more of the following: 1) signs of HF 2) evidence of a low-output state 3) increased risk* for cardiogenic shock 4) other relative contraindications to beta blockade (PR interval greater than 0.24 s, second or third degree heart block, active asthma, or reactive airway disease). *Risk factors for cardiogenic shock (the greater the number of risk factors present, the higher the risk of developing cardiogenic shock): age greater than 70 years, systolic blood pressure less than 120 mmHg, sinus tachycardia greater than 110 or heart rate less than 60, increased time since onset of symptoms of UA/NSTEMI. Chen ZM, et al. Lancet 2005;366:1622–32.
Antiplatelet Therapy I IIa IIb III Aspirin should be administered to UA/NSTEMI patients as soon as possible after hospital presentation and continued indefinitely in patients not known to be intolerant of that medication. I IIa IIb III LD added Clopidogrel (loading dose [LD] followed by daily maintenance dose) should be administered to UA/NSTEMI patients who are unable to take ASA because of hypersensitivity or major gastrointestinal intolerance. *Some uncertainty exists about optimum dosing of clopidogrel. Randomized trials establishing its efficacy and providing data on bleeding risks used a loading dose of 300 mg orally followed by a daily oral maintenance dose of 75 mg. Higher oral loading doses such as 600 or 900 mg of clopidogrel more rapidly inhibit platelet aggregation and achieve a higher absolute level of inhibition of platelet aggregation, but the additive clinical efficacy and the safety of higher oral loading doses have not been rigorously established.
Page 1: Acute Coronary Syndrome: Thoughts o
Page 4 and 5: Case 1 • Exam: • 142/74, HR 88,
Page 6 and 7: Case 1 • Arrival to ED: • ECG
Page 8: Case 1 • Decision made to pursue
Page 12: Evidence Based Data
Page 15 and 16: Variables Used in the TIMI Risk Sco
Page 17 and 18: I IIa IIb III Updated Guidelines Cl
Page 19 and 20: Initial Chest Pain Evaluation Sympt
Page 24 and 25: Lipid Management I IIa IIb III I I
Page 26 and 27: Pravastatin Or atorVastatin Evaluat
Page 28 and 29: Diabetes Mellitus I I I IIa IIb III
Page 30 and 31: Weight Management I IIa IIb III New
Page 32 and 33: Depression I IIa IIb III It is reas
Page 34 and 35: Early Risk Stratification I IIa IIb
Page 36 and 37: Timing of Release of Various Biomar
Page 38 and 39: Immediate Management I IIa IIb III
Page 42 and 43: Antiplatelet Therapy I IIa IIb III
Page 44 and 45: Initial Conservative Versus Initial
Page 50 and 51: I IIa IIb III Hospital Care Conserv
Page 52 and 53: Risk Factor Modification I IIa IIb

Acute Coronary Syndrome

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