• Ensure adequate oxygenation

• Correct hypotension and tissue hypoperfusion

• Consider drug causes, e.g. vasopressors

• Glyceryl trinitrate 0.5mg SL, or nitrolingual spray (0.4-0.8mg) repeated as necessary

• If symptoms are severe and/or persisting, maintain bed rest

• Aspirin 75mg od PO (unless contraindicated).

For continuing angina:

• IV Nitrate infusion, e.g. glyceryl trinitrate, isosorbide trinitrate

• Consider calcium antagonist, e.g. diltiazem though not alone

• Consider (-blocker (unless contraindicated), e.g. propranolol, atenolol

• LMW heparin and clopidogrel (unless contraindicated)

• Consider GP2b3a inhibitor (IV eptifibatide or tirofiban) in addition to aspirin and clopidogrel if considered at high risk of MI or death

• If symptoms or ST-segment changes persist despite optimal pharmacological intervention, inform cardiologist with a view to angiography and possible angioplasty or surgery.


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