. 2003 Jul 3;14(2):67–73.

Table 6.

Assessment and treatments of acute coronary syndrome

Initial assessment	Specific treatments
1 Targeted history, including AMI inclusions, thrombolytic exclusion 2 Vital signs and focused physical examination 3 12-lead ECG; serial ECGs as needed 4 Chest x-ray (preferably upright) 5 ECG monitoring	Reperfusion therapy: goals 10 Thrombolytic agents: door-to-needle time <30 min 11 Primary PTCA: door-to-dilation time <60 min Conjunctive therapy (combined with thrombolytic agents) 12 Aspirin 13 Heparin (especially with TPA) Adjunctive therapies 14 ß-Adrenoceptor blockage if eligible 15 IV nitroglycerin (for anti-ischemic and antihypertensive effects) 16 ACE inhibitor (especially large anterior wall MI, heart failure without hypotension [SBP >100 mm Hg], previous MI)
Initial general treatment (memory aid: MONA)
6 Morphine 2-4 mg q 5-10 min to provide adequate analgesia 7 Oxygen at 4 L/min; continue if arterial oxygen saturation <90% 8 Nitroglycerin sublingual or IV; tests for Prinzmetal’s angina, reversible spasm; has anti-ischemic, antihypertensive effects 9 Aspirin 160-325 mg (chew and swallow)

Initial assessment

Specific treatments

Reperfusion therapy: goals

Conjunctive therapy (combined with thrombolytic agents)

Adjunctive therapies

14 ß-Adrenoceptor blockage if eligible
15 IV nitroglycerin (for anti-ischemic and antihypertensive effects)
16 ACE inhibitor (especially large anterior wall MI, heart failure without hypotension [SBP >100 mm Hg], previous MI)

Initial general treatment (memory aid: MONA)

6 Morphine 2-4 mg q 5-10 min to provide adequate analgesia
7 Oxygen at 4 L/min; continue if arterial oxygen saturation <90%
8 Nitroglycerin sublingual or IV; tests for Prinzmetal’s angina, reversible spasm; has anti-ischemic, antihypertensive effects
9 Aspirin 160-325 mg (chew and swallow)

SBP indicates systolic blood pressure.