STEMI

NSTEMI

ECG Changes

MI - Secondary Prevention

Post-MI complications

Acute coronary syndrome can be classified as follows:

• ST-elevation myocardial infarction (STEMI): ST-segment elevation + elevated biomarkers of myocardial damage
• non ST-elevation myocardial infarction (NSTEMI): ECG changes but no ST-segment elevation + elevated biomarkers of myocardial damage
• unstable angina

The management of ACS depends on the particular subtype. NICE management guidance groups the patients into two groups:

• 1. STEMI
• 2. NSTEM/unstable angina

Common management of all patients with ACS

Initial drug therapy

• aspirin 300mg
• oxygen should only be given if the patient has oxygen saturations < 94% in keeping with British Thoracic Society oxygen therapy guidelines
• morphine should only be given for patients with severe pain
  • previously IV morphine was given routinely
  • evidence, however, suggests that this may be associated with adverse outcomes
• nitrates
  • can be given either sublingually or intravenously
  • useful if the patient has ongoing chest pain or hypertension
  • should be used in caution if patient hypotensive