Unstable angina (USA)



Print version Management ACS.


Heart score

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

Other agents

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)

Cardiology 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. Last review D. ÍOS 21/06/21.