ÎÎAn ACE inhibitor should be administered orally within the first 24 h
to UA/NSTEMI patients with pulmonary congestion or LV ejection
fraction (LVEF) less than or equal to 0.40, in the absence of
hypotension (systolic blood pressure <100 mm Hg or >30 mm
Hg below baseline) or known contraindications to that class of
medications. (I-A)
ÎÎAn angiotensin receptor blocker (ARB) should be administered to
UA/NSTEMI patients who are intolerant of ACE inhibitors and have
either clinical or radiological signs of HF or LVEF less than or equal to
0.40. (I-A)
ÎÎBecause of the increased risks of mortality, reinfarction, hypertension,
HF, and myocardial rupture associated with their use, nonsteroidal
anti-inflammatory drugs (NSAIDs), except for ASA, whether
nonselective or cyclooxygenase (COX)-2–selective agents, should be
discontinued at the time a patient presents with UA/NSTEMI. (I-C)
ÎÎIt is reasonable to administer supplemental oxygen to all patients with
UA/NSTEMI during the first 6 h after presentation. (IIa-C)
ÎÎIn the absence of contraindications to its use, it is reasonable to
administer morphine sulfate intravenously to UA/NSTEMI patients if
there is uncontrolled ischemic chest discomfort despite NTG, provided
that additional therapy is used to manage the underlying ischemia.
(IIa-B)
ÎÎIt is reasonable to administer intravenous (IV) beta blockers at the
time of presentation for hypertension to UA/NSTEMI patients who do
not have one or more of the following: (IIa-B)
•
•
•
•
Signs of HF
Evidence of a low-output state
Increased risk for cardiogenic shock
Other relative contraindications to beta blockade (PR interval >0.24 s, secondor third-degree heart block, active asthma, or reactive airway disease).
ÎÎOral long-acting nondihydropyridine calcium channel blockers are
reasonable for use in UA/NSTEMI patients for recurrent ischemia in
the absence of contraindications after beta blockers and nitrates have
been fully used. (IIa-C)
ÎÎAn ACE inhibitor administered orally within the first 24 h of
UA/NSTEMI can be useful in patients without pulmonary congestion or
LVEF less than or equal to 0.40 in the absence of hypotension (systolic
blood pressure <100 mm Hg or >30 mm Hg below baseline) or known
contraindications to that class of medications. (IIa-B)
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