AHA NSTE-ACS Guidelines - Free

8 Treatment Table 6. Standard Medical Therapies Recommendations COR LOE Oxygen Supplemental oxygen should be administered to patients with NSTE-ACS with arterial oxygen saturation <90%, respiratory distress, or other high-risk features of hypoxemia. I C Nitrates Patients with NSTE-ACS with continuing ischemic pain should receive sublingual nitroglycerin (0.3-0.4 mg ) every 5 min for ≤3 doses, aer which an assessment should be made about the need for intravenous nitroglycerin if not contraindicated. I C Intravenous nitroglycerin is indicated for patients with NSTE-ACS for the treatment of persistent ischemia, HF, or hypertension. I B Nitrates should NOT be administered to patients with NSTE-ACS who recently received a phosphodiesterase inhibitor, especially within 24 h of sildenafil or vardenafil, or within 48 h of tadalafil. III: Harm B Analgesic therapy In the absence of contraindications, it may be reasonable to administer morphine sulfate intravenously to patients with NSTE- ACS if there is continued ischemic chest pain despite treatment with maximally tolerated anti-ischemic medications. IIb B NSAIDs (except ASA) should NOT be initiated and should be discontinued during hospitalization for NSTE-ACS because of the increased risk of MACE associated with their use. III: Harm B Beta-adrenergic blockers Oral beta-blocker therapy should be initiated within the first 24 h in patients who do not have any of the following : 1) signs of HF, 2) evidence of low-output state, 3) increased risk for cardiogenic shock, or 4) other contraindications to beta blockade (e.g., PR interval >0.24 second, second- or third-degree heart block without a cardiac pacemaker, active asthma, or reactive airway disease). I A In patients with concomitant NSTE-ACS, stabilized HF, and reduced systolic function, it is recommended to continue beta- blocker therapy with 1 of the 3 drugs proven to reduce mortality in patients with HF: sustained-release metoprolol succinate, carvedilol, or bisoprolol. I C Patients with documented contraindications to beta blockers in the first 24 h of NSTE-ACS should be reevaluated to determine their subsequent eligibility. I C It is reasonable to continue beta-blocker therapy in patients with normal LV function with NSTE-ACS. IIa C Administration of intravenous beta blockers is potentially harmful in patients with NSTE-ACS who have risk factors for shock. III: Harm B

• Cover
• Table of Contents
• Key Points
• Diagnosis
• Treatment
• Evidence Grading
• Abbreviations and Sources
• Algorithm for Patients with NSTE-ACS
• Special Patient Groups
• Standard Medical Therapies
• Initial Anticoagulant Therapy
• Early Invasive and Ischemia Guided Strategies