NSTEMI treatment
Posted by dkwinter

Supplemental oxygen


Antiplatelet therapy

  • ASA 162 mg PO to chew STAT followed by 81 mg PO daily
  • AND
  • Plavix 300 mg PO STAT followed by 75 mg PO daily
    • 600 mg dose if pt to undergo emergent PCI within 24 hours of diagnosis (decr risk of stent thrombosis)




Treat HTN and tachycardia with beta-blocker

  • metoprolol 5mg IV q5min up to three doses then switch to PO: 25-50 mg q6-12h, adjusting to BID


Lipid therapy/plaque stabilization with statin

  • Lipitor 80 mg PO STAT and then continue qhs


Treat ischemia with nitroglycerin (glyceryl trinitrate)

  • use caution if RV infarction or severe aortic stenosis
  • contraindicated if PDE-5 inhibitor use in prior 24 hours
  • spray PRN
  • patch starting at 0.4 mg/hour (avail as 0.2 mg/h, 0.4 mg/h, 0.6 mg/h, 0.8 mg/h)
    • ​use 24*7 initially
  • IV drip starting at 5 mcg/min
    • increasing by 5 mcg/min every 3-5 min up to 20 mcg/min
    • then increase by 10-20 mcg/min every 3-5 min up to max dose 400 mcg/min


Treat pain (very conservatively--evidence of decreased survival with use)

  • morphine 2-4 mg IV repeated every 5 to 15 minutes, increasing by 2-8 mg each dose PRN


If cocaine-associated then

  • Use benzodiazepines
  • Do not use beta-blockers (dogma of unopposed alpha that recent evidence challenges)


Management strategy

  1. Angiography +/- PCI or stenting OR CABG
  2. Conservative/medical management