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ACUTE CORONARY SYNDROMES W/OUT PERSISTENT ST-SEGMENT ELEVATION
Acute coronary syndromes refer to any constellation of clinical symptoms compatible with acute myocardial ischemia which may be life-threatening.
It encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
Unstable angina is the ischemic discomfort that presents without persistent ST-segment elevation on ECG and without the presence of cardiac markers in the blood.
Non-ST-segment elevation myocardial infarction is diagnosed if cardiac markers are positive with ST-segment depression or with nonspecific or normal ECGs.
The patient typically presents with ischemic-type chest pain that is severe and prolonged and may occur at rest or may be caused by less exertion than previous episodes.

Supportive Therapy

Bed Rest

  • Usually prescribed initially in patients with UA/NSTEMI while ischemia is ongoing
    • Patient can be mobilized to bedside commode or chair when symptom-free
  • Ambulation as tolerated may begin once patient has been hemodynamically stable without recurrent symptoms for 12-24 hours
    • Subsequent activity should not be inappropriately restricted
    • Focus should be on the prevention of recurrent symptoms and activity may be increased once patient responds to therapy

Supplemental O2

  • Give supplemental O2 to all patients with overt pulmonary congestion or arterial O2 saturation <90% or respiratory distress or other high-risk features of hypoxemia
  • Consider in all patients with ACS for the 1st 6 hours of therapy
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