into:
Unstable Angina
Occurs at rest and prolonged, usually lasting >20
minutes
New onset angina that limits activity
Increasing angina: Pain that occurs more frequently,
lasts longer periods or is increasingly limiting the
patients activity
EKG
STEMI:
EKG
NSTEMI:
Unstable Angina:
Cardiac Enzymes
Troponin is primarily used for diagnosing MI
Age>=65
>= 3 CAD risk factors:
0-2: Low
3-4: Intermediate
risk:
Telemetry
Rule out ACS with 3 sets of troponin, EKG
Consider pre-discharge stress test
STEMI Management
STEMI patients usually go straight to the cath lab from
Cardiac monitor
Supplemental O2
Nitrates*
Beta blocker
Morphine
Clopidogrel
Aspirin
Good IV access
Call cardiology fellow!
References
2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
www.uptodate.com:
Overview of the acute management of unstable angina and acute non-ST elevation myocardial infarction
Initial evaluation and management of suspected acute coronary syndrome in the emergency department
Criteria for the diagnosis of acute myocardial infarction