e-discussion on Emerging trends in therapeutics of ACS

[Guest guest]

Dear Members,Class I

Recommendations for Anti-Ischemic Therapy

Nonpharmacological

care

Ø

Bed rest for all patients.

Ø

Continuous electrocardiographic

monitoring for patients with ongoing chest pain at rest.

Ø

Supplemental oxygen for patients with

cyanosis or respiratory distress.

Ø

Finger pulse oximetry or arterial

blood gas measurement for patients with hypoxemia determination to confirm

adequate arterial oxygen saturation.

Pharmacological

care

Ø

Nitroglycerin, sublingual tablet or

spray, followed by intravenous administration for all patients.

Ø

Morphine sulfate, intravenously for

patients who have symptoms that are not immediately relieved with nitroglycerin

or who have acute pulmonary congestion, severe agitation, or both.

Ø

β-Blocker, intravenous, followed by

oral administration (if not contraindicated) for patients with ongoing chest

pain.

Ø

Nondihydropyridine CCB as initial

therapy in the absence of severe LV dysfunction or other contraindications for

patients with continuing or frequently recurring ischemia when β-blockers are contraindicated.

Ø

ACE inhibitor for patients with

hypertension despite treatment with nitroglycerin and a β-blocker and with LV

systolic dysfunction or CHF; patients with diabetes.

ACE = angiotensin-converting enzyme; CCB = calcium channel

blocker; CHF = congestive heart failure; LV = left ventricular.

Regards,Tarun Wadhwa