Acute coronary syndrome

Diagnosis and treatment

  1. STEMI
  2. NSTEMI
  3. Treatment
  4. Scores
  5. Pharmaceuticals
  6. ESC recommandations (NSTEMI)
  7. ESC recommandations (STEMI)

Treatment

  1. STEMI treatment
  2. Treatment of confirmed NSTEMI
  3. Treatment of an unconfirmed STEMI.

Treatment of confirmed NSTEMI

Cardiac monitoring/Defibrillator (SI/SC), Venflon LSA. Oxygen.

  • Aspirin 500mg iv bolus.
  • One of the following drug:
    • Ticagrelor (Brilique) 180mg (2cps of 90mg) orally.
    • Prasugrel (Efient) 60 mg (6 cps of 10mg) orally.
    • Clopidogrel (Plavix) 600 mg (8cps of 75mg or 2cps of 300mg) orally.
  • One of the following drug:
  • Morphine and Nitrates if needed
  • Based on clinical evalutation: ß-blockers (ex.metoprolol (Lopresor) 5mg iv slow, 3 times in 15 minutes) CAVE: Inferiror infarction.
  • Coronarography et angioplasty within 24-48 hours.

Note for heparines: Fondaparinus (Arixtra) should be preferred (less bleeding) after angioplasty. Heparine unfractionned should be preferred immediately after angioplasty (risk of catheter thrombosis during catheterism).