Snapshot A 50-year-old man presents to the emergency department after experiencing chest pain. He describes the pain as pressure-like that affects the sternum and radiates down the left arm. Medical history is significant for hypertension, hypercholesterolemia, and type II diabetes. He smokes 1 pack of cigarettes per day for the past 20 years. On physical exam, the patient appears anxious and diaphoretic. An electrocardiogram demonstrates an ST-segment elevation in leads V1 and V2. Cardiac troponins are sent. He is given aspirin, nitroglycerin, metoprolol, clopidogrel, and unfractionated heparin. The cardiac catheterization lab is activated and the cardiologist is consulted. Introduction Appropriate treatment for acute coronary syndrome must be instituted immediately in order to limit myocardial damage decrease the risk of complications restore the balance between myocardial oxygen supply and demand NSTEMI and Unstable Angina (UA) Introduction NSTEMI and UA are managed in the same manner the goal is to to provide anti-ischemic therapy login to view 1 more bullet anti-thrombotic therapy login to view 1 more bullet Medications anti-ischemic therapy β-blockers (e.g., metoprolol) login to view 10 more bullets nitrates (e.g., nitroglycerin, isosorbide mononitrate, and dinitrate) login to view 12 more bullets calcium channel blockers (e.g., verapamil and diltiazem) login to view 4 more bullets anti-thrombotic therapy aspirin login to view 4 more bullets P2Y12 ADP receptor inhibitor (e.g., clopidogrel and ticagrelor) login to view 2 more bullets anti-coagulation therapy unfractionated heparin login to view 3 more bullets ST-Segment Elevation Myocardial Infarction (STEMI) Introduction STEMI suggest that there is a total occlusion of the vessel thus the main goal is to induce rapid reperfusion via login to view 2 more bullets patients are also given medications such as those used in NSTEMI and UA login to view 5 more bullets Reperfusion therapy primary PCI the preferred method for reperfusion must be performed within 90 minutes of first medical contact login to view 1 more bullet fibrinolytic therapy (e.g., alteplase) performed if PCI cannot be performed within 90 minutes or is unavailable fibrinolytics convert plasminogen to plasmin, which degrades newly formed clots Adjunctive Therapy Angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril) provides a mortality benefit prevents ventricular cardiac remodeling and reduces the rate of heart failure Statins (e.g., atorvastatin) an HMG-CoA reductase inhibitor that lowers cholesterol levels