Definition of ACS (acute coronary syndrome).
Diagnosis
See workup for chronic stable angina in the clinic setting.
Treatment
-Send the patient to the ED immediately.
Some of the following will be done in the ED, do what you can with clinic resources.
-Morphine prn pain.
–Oxygen only if need to keep SaO2 > 91%.
-NTG PRN, chest pain
-Aspirin. The first tab is 325 (chew), then 81mg QD after that.
-Beta-blocker. Metoprolol 25-50 mg po q6h, titrate to keep HR 50-60
-ACE. Watch BP. May wait to see BB work if concerned about BP or start low dose, e.g. Lisinopril 5mg po BID
-Statin. High-intensity statin – atorvastatin 80mg po Qbedtime
-Heparin or other.-Will start anticoagulation.
The hospital will decide on the need for a stress test, a transthoracic echocardiogram (to look for new wall motion abnormality), and angiography.
