Non-ST Elevation Myocardial Infarction (NSTEMI)

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NSTEMI

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NSTEMI
-ECG shows NSTEMI, troponin positive, CXR and CT do not show pneumothorax or  aortic dissection.
–TIMI score >3
-Trend cardiac enzymes: troponin, CK-MB/CK.
-Obtain CBC, chemistry, liver function tests, and lipase.
-Ordered Aspirin 300 mg + Ticagrelor 60mgx1 at PCI or Plavix 300-600mg x1 followed by 75mg QD. 
-Will start high intensity statin + ACEI. If BP stable, start BB/Metoprolol 25-50mg q6hr to HR 60.
-Started Heparin bolus and IV Heparin infusion, as patient has no contraindications.
-Nitro patch and/or Morphine for pain and nasal cannula for O2. Cautious Nitro/Morphine in inferior wall infarct due to hypotension.
-Will start Epleronone/ Spironalactone, if LVEF <40% 3 days post MI.
-Cardiology consulted,  PCI w/24hrs. 
-Monitor for hemodynamic instability, heart failure, rest angina despite therapy, MR, murmur or arrhythmia, as patient will need emergent angiography.
-IABP for refractory angina, if PCI not available.
-Monitor for complications including pulmonary edema and hypotension which may be signs of cardiac muscle & wall rupture acute decompensation.
-May require ICD post discharge, if meeting indications.
-Will screen for depression.