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)

 

Anticoagulant

• Lovenox 1mg/kg SC q12h STAT
  • Dose reduction only if CrCl <30
    • See http://www.uptodate.com/contents/enoxaparin-drug-information for details
  • Consider decreased dose in elderly patients who are <45 kg

 

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

 

 

Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.

The Compendium platform was created by David Kwinter, MD, CCFP(EM).

Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.