Unstable angina (USA)

Management suspected ACS in Munster
Management of suspected ACS in Munster

Heart score

HEART Score for Chest Pain Patients in the ED
History
  • Highly suspicious
  • Moderately suspicious
  • Slightly/non-suspicious
  • 2 points
  • 1 point
  • 0 points
ECG
  • Significant ST-depression
  • Non-specific re-polarisation
  • Normal
  • 2 points
  • 1 point
  • 0 points
Age
  • ≥65 years
  • >45-65 years
  • <45 years
  • 2 points
  • 1 point
  • 0 points
Risk factors
  • x 3 risk factors or Hx CAD
  • 1 -2 risk factors
  • No risk factors
  • 2 points
  • 1 point
  • 0 points
Troponin
  • >x3 normal limit
  • >1 - <3 normal limit
  • Normal limit
  • 2 points
  • 1 points
  • 0 points
Risk factors: DM, smoker, ↑BP, FHx of CAD, ↑Lipids
Score 0-3: 2.5% MACE over next 6/52 » Discharge home
Score 4-6: 20.3% MACE over next 6/52 » Refer cardiology
Score 7-10: 72.7% MACE over next 6 weeks » Admit cardiology

TIMI risk score in USA/NSTEMI

Historical Y
Age ≥65 1
≥3 risk factors * CAD 1
Known CAD (stenosis ≥50%) 1
ASA use in past 7 days 1
Presentation  
Recent (≤24H) severe angina 1
↑cardiac markers 1
ST deviation ≥0.5mm 1

* FHx, Smoker, ↑Chol, Diabetes, ↑BP

Antiplatelet agents

  • Aspirin (325mg PO then 75mg PO OD).
  • Clopidogrel (300mg PO load then 75mg PO OD).
  • Avoid clopidogrel if suspected left main stem stenosis..]

Antithrombin Agents

  • Heparin (80U/kg bolus then titrated 18U/kg/h to APTT of 50 to 70s.
  • Enoxaparin (1mg/kg SC BD).
    • Discuss with cardiology if pre-angio.

Others

  • β blockers.
  • Nitrates (IV).
  • Thrombolysis in AMI.
  • ACEI (at 24 hours).
  • PCI ? AMI.
  • Atorvastatin (at 24 hours).

Letter Dr Colm Henry, medical Director MUH, Re Management ACS at MUHCardiology Review in MUH

In the case of urgent clinical problems (unstable arrhythmia, STEMI or NSTEMI with pain) patients should be reviewed by:

09:00 to 17:00 Cardiology registrar if available, medical registrar on call if not.

17:00 to 09:00 Medical registrar on call or city-wide cardiology registrar on call (via switch).

All other problems requiring admission should be referred to the medical team on call. The cardiology Intern should not be called.

Content by Dr Íomhar O' Sullivan. Reviewed by Dr ÍOS 27/03/2007.  Last review D. ÍOS 11/03/17.