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.

STEMI treatment

Oxygen, Cardiac monitoring/Defibrillator (CCU), Venflon left superior arm

  • Aspirin 500mg iv bolus
  • Oxygène si Sat = 2 < 90%
  • Prasugrel (Efient) 60 mg (6 cps of 10mg) orally in bolus, Ticagrelor (Brilique) 180 mg or Clopidogrel (Plavix) 600 mg (8 cps de 75mg or 2 cps of 300mg)]
  • Héparine (Liquémine) 5000-7500 UI iv bolus or Enoxaparine (Clexane) 30mg iv + completed to 1.0mg/kg PC sc) (note time !)
  • Morphine and nitrates if needed
  • Based on clinical evaluation: ß-Blockers (ex. Lopresor 5mg iv slow, 3x in 15 minutes) CAVE: Inferior infarction
  • Transfer patient for coronarography and percutaneous inervention (PCI).

Note for thienopyridines:

Clopidogrel (Plavix) or Ticagrelor (Brilique) if high risk of hemorhage (age > 75, weight < 60kg, renal failure with CrCl < 30ml/min, Status post CVA; or Mehran score > 25 pts)

Prasugrel (Efient) or Ticagrelor (Brilique) for the other patients.