Classification
Unstable angina (ischemia without biomarker elevation), NSTEMI (biomarker without ST elevation), STEMI (ST elevation, transmural). All from disrupted plaque with thrombosis.
Immediate Management
MONA-BASH: Morphine, Oxygen (SpO2 <90), Nitroglycerin, Aspirin 325 mg, Beta-blocker, ACE, Statin, Heparin. STEMI: PCI within 90 min or thrombolytics within 30 min. NSTEMI: anticoagulation, PCI 24-72h.
Ongoing Care
DAPT: aspirin + P2Y12 inhibitor for 12 months post-stent. Cardiac rehab, lifestyle modification, medication adherence. Echo for LV function. Risk factor modification: LDL <70, BP, diabetes, smoking.
Important Notes
- STEMI is time-critical — every 30 min delay in reperfusion increases mortality by 7.5%.
- Door-to-balloon time must be <90 min — time is muscle.
Clinical Tips
- Troponin peaks 12-24h and remains elevated 7-10 days — trend is more useful than single values.
- Prasugrel contraindicated in patients >75 or with history of stroke/TIA.
Summary
ACS requires immediate antiplatelet therapy, anticoagulation, and timely reperfusion to minimize myocardial damage.
