GUIDELINES FOR RISK STRATIFICATION & MANAGEMENT OF ACUTE CORONARY SYNDROMES

(Excluding ST elevation Myocardial Infarction)

MANAGEMENT OF ACUTE CORONARY SYNDROMES

RISK STRATIFICATION (Excluding ST elevation Myocardial Infarction)

HIGH RISK ACUTE CORONARY SYNDROMES

(Excluding STEMI)

1. Prolonged (>20min) or recurrent chest pain not

responding to medical management RISK STRATIFICATION
From history, physical examination, ECG
2. Haemodynamic instability (evidence of heart failure monitoring, blood samples
or hypotension
3. Life threatening arrhythmias (VT or VF)
4. 2mm or more ST segment depression in multiple
HIGH RISK INTERMEDIATE RISK LOW RISK
(≥5) ECG leads
5. Elevated troponin levels

• Aspirin + Clopidogral • Aspirin + Clopidogral • Aspirin + Clopidogral

• LMWH or UFH
INTERMEDIATE RISK • Nitroglycerin
• Morphine sulphate
• Beta blocker
1. Prolonged (>20min) or recurrent chest pain • Statin
• GP IIb/IIIa receptor
responding to medical management blocker
2. Early post infarction angina (if indicated)
• LMWH or UFH • Beta blocker
• Nitroglycerin • Statin
• Morphine sulphate • Oral nitrates
• Beta blocker (if indicated)
• Statin

3. 2mm or more ST segment depression in < 5 leads

No response to medical
therapy
LOW RISK • ongoing typical angina
Responds to maximum
medical therapy
• haemodynamically
unstable
1. No recurrence of chest pain after admission
2. No elevation of biochemical cardiac markers
3. No ST segment depression
4. Normal ECG TRANSFER TO FULL
FACILITY CARDIAC CENTRE
POST DISCHARGE RISK
STRATIFICATION
After discussion with To assess for inducible
Consultant