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• Start appropriate therapies: Heparin, Elevated Troponin or • Possible admission: monitor serial
NTG, β-blockers high-risk patient ECG and cardiac markers.
• Reperfusion Therapy STAT Signs for invasive therapy: • Consider non-invasive testing like
Continued chest discomfort treadmill or thallium stress test.
Continued ST deviation
Unstable hemodynamics
Symptoms ≤ 12 hrs Heart Failure
YES
NO Ventricular Tachycardia
Develops 1 or more:
• ECG changes (ST elevation/depression)
• Troponin Elevated
YES • Worsening chest discomfort or
Adjunctive Therapies arrhythmias
Nitroglycerine (IV/PO)
Heparin (IM/IV)
Possibly: β-blockers NO
Possibly: Clopidogrel
Possibly: Glycoprotein Iib/IIIa inhibitor
Goal for stent placement or balloon • Admit to monitored bed • Abnormal results from non-
inflation should be within 90 • Continue ASA, heparin, and other invasive diagnostic tests
minutes indicated therapies. mentioned above
• ACE Inhibitors/ARB • Abnormal results from ECG or
Goal for fibrinolysis should be 30 • Statin Therapy YES troponin
minutes • Expert consultation to assess
cardiac risk factors
NO