I25.2/I20.0
GENERAL MEASURES
Lifestyle modification. See: Ischaemic heart disease and atherosclerosis, prevention.
MEDICINE TREATMENT
Continue oral therapy as above.
If heart failure develops, replace atenolol with carvedilol.
See: Congestive cardiac failure .
REFERRAL
- Patients with a diagnosis of acute coronary syndrome should be risk stratified at presentation to estimate their likelihood of developing a major adverse cardiac event (acute MI, heart failure, death or readmission for UA) over the subsequent 4-6 weeks. High risk patients (including those with positive troponins) should be discussed with a cardiology service for consideration for angiography and revascularization therapy. , Two widely used and well validated risk stratification scores are TIMI (http://www.mdcalc.com/timi-risk-score-for-uanstemi/) and Grace Risk Scores (http://www.mdcalc.com/grace-acs-risk-and-mortality-calculator). The patient’s co-morbidities and willingness to undergo revascularisation, which may involve coronary surgery, should be taken into account when advising such referral.
- Other important indications for referral include ongoing chest pain, post-infarct angina, sustained dysrhythmias or refractory heart failure.