When you're treating a non-ST elevation myocardial infarction (an NSTEMI), keep OH BATMAN in mind. The mnemonic works for treating unstable angina, too.
O = oxygen: Ischemia implies oxygen deprivation, which leads to increased myocardial oxygen demand and increased myocardial work. The goal of treatment is to reduce the workload of the heart. Every person admitted to the hospital with acute coronary syndrome (ACS) is given oxygen via nasal cannula.
H = heparin: This blood thinner works by potentiating antithrombin III. Its purpose is to prevent clotting and to thin the blood during an ACS. Heparin can be given for unstable angina, but it's almost always given to a person with an NSTEMI.
B = beta blocker: This is a standard of care for anyone with ACS, both an NSTEMI and a STEMI. It decreases the workload of the heart and should improve morbidity and mortality. The most common beta blockers used are metoprolol (Lopressor) and atenolol (Tenormin).
A = aspirin: Anyone with an MI needs to chew an aspirin right away. It's an antiplatelet agent that has saved countless lives.
T = thrombolysis: Use thrombolysis in the setting of a STEMI if and only if cardiac catheterization can't be done within a few hours of the ischemic event.
M = morphine: Morphine is for managing the pain associated with an MI. You can also use it in treating CHF/pulmonary edema.
A = ACE inhibitors: ACE inhibitors can help preserve myocardium in the setting of an MI. They're usually given in the first 24 hours unless acute kidney failure is present.
N = nitroglycerin: This coronary artery vasodilator helps in the management of ACS. In the setting of an NSTEMI, nitroglycerin is usually given as a continuous infusion along with heparin. It can also be given as a pill (isosorbide mononitrate, brand name Imdur) or as a topical nitropaste applied across the chest.
The person with ACS is going to be on multiple treatments at one time. For example, the person with an NSTEMI will be on IV heparin and nitroglycerin, on oxygen via nasal cannula, and on oral metoprolol.
Just because someone comes into the hospital on warfarin (Coumadin) doesn't mean that he or she can't have an MI. Coumadin isn't an antiplatelet drug. It works on the extrinsic clotting pathway. Coumadin won't inhibit platelet aggregation/clumping, which is why aspirin and clopidrogel (Plavix) are used in treating ACS.
