TREATMENT
UA requires more aggressive treatment than stable angina, and is similar to
treatment for NSTEMI:Goals of care (ED core measures) from time of arrival to ED (see Table 2.5)
■ ASA given on arrival (unless contraindicated)
■ ECG interpreted by physician within 10 minutes
■ If STEMI:
■ Door to needle (if fibrinolytics utilized) <30 minutes
or
■ Activation of catheterization team <30 minutes anddoor to catheteri-
zation time <90 minutes
■ β-Blockers within 24 hoursMedications
■ O 2
■ May reduce the area of ischemia
■ Uncertain benefit in the literature, but easy and safe (even in the COPD
patient)
■ Aspirin
■ Antiplatelet agent—irreversibly inhibits platelet cyclooxygenase activity,
thereby inhibiting the formation of thromboxane A 2
■ Onset of action is minutes.
■ ↓Long-term mortality (to the same degree as thrombolytics!)
■ Use with caution with active peptic ulcer disease (consider rectal
administration).
■ Clopidogrel (Plavix) or ticlodipine (Ticlid)
■ Antiplatelet agent—irreversibly inhibits platelet aggregation via adeno-
sine diphosphate receptor antagonism
■ Onset of action is hours.
■ Indicated in patients with aspirin allergy
■ Do not use in patients who may require a surgical intervention (CABG)
within the next 5 days.
■ Nitroglycerin
■ Sublingual X 3, then IV if symptoms persist
■ Dilates coronary arteries and relaxes vascular smooth muscle, resulting
in decreased preload/afterload and decreased myocardial O 2 demandCARDIOVASCULAR EMERGENCIES
TABLE 2.5. ED Core Measures for ACS (From Time-of-Arrival to ED)ASA on arrivalECG interpreted within 10 minIf STEMI:
■Door to needle (fibrinolytics) <30 min
or
■activation of catheter team <30 min
and
■door to catheterization <90 minβBlockers within 24 hAspirin is the most cost-
effective treatment available
for patients with ACS. It
independently reduces
mortality of patients with MI.In patients who present to the
ED with chest pain, the ECG
should be interpreted by the
physician within 10 minutes
of patient’s arrival.