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ACUTE CORONARY SYNDROME

CHEST PAIN
O2 therapy/ Cardiac monitor/ Vital signs

ST- Elevation AMI Unstable Angina


/ New LBBB ECG &/or Suspected AMI
Notify Registrar Notify Registrar
AMI Pathway ACS Pathway

Follow AMI Management if:


ST elevation
greater than or equal to 1mm S/L Anginine / Aspirin
S/L Anginine / Aspirin in any 2 of Leads 1, AVL ,11, 111 IV Access
IV Access X 2 or AVF GTN / Morphine
GTN / Morphine or Pathology
Pathology ST elevation
greater than or equal to 2mm
in 2 or more of Leads V2-V6
or
New LBBB
or Repeat ECG 30 mins
True Posterior ( Tall R waves & ST
depression V1V1-V3,
V3 do posterior leads )
or
Consider Thrombolysis
RV Infarction (ST elevation V4R)
If <12hrs since symptom onset
(If ST elevation II, III, AVF, do Right sided ECG)
Tenecteplase®
If LBBB, &/or relative
contraindications discuss with
Physician

Acute ECG
changes

YES NO

Enoxaparin Admit to ICU (unless > 80 years)


(unless contraindicated) ST segment monitoring.
Troponin 6/24 for 12 hours
Consider discharge if Troponin negative.
Tenecteplase® Anticoagulant therapy - Enoxaparin.
Aim: < 60 minutes Door (unless has heparin infusion)
to needle time +/-
and Beta blocker
Heparin Infusion. Ace inhibitors
anti platelet therapy