Algorithm
- Call for help; 12-lead ECG within 10 min; aspirin 300 mg chewed if not contraindicated.
- High-flow oxygen only if SpO₂ <94%; IV access ×2; monitor BP, rhythm, pain.
- STEMI: urgent reperfusion — primary PCI within 120 min or fibrinolysis if PCI unavailable.
- NSTEMI/unstable angina: anticoagulation + dual antiplatelet; early invasive strategy if high risk.
- Morphine only if severe pain after nitrates; avoid routine morphine if possible.
- Treat complications: arrhythmia, cardiogenic shock, acute pulmonary edema.
Red flags
- • Ongoing ischemic pain, hemodynamic instability, or acute heart failure
- • Contraindications to reperfusion therapy — involve cardiology urgently
- • Cardiac arrest — follow ACLS
Medications by step
Step 1 — Antiplatelet
- Aspirin · p.o.
300 mg PO chewed, then 75–100 mg daily
- Ticagrelor · p.o.
180 mg loading, then 90 mg BID
Step 2 — Anticoagulation
- Heparin (UFH) · i.v.
60 IU/kg bolus (max 4000 IU), then infusion
Step 3 — Reperfusion adjunct
- Tenecteplase · i.v.
Weight-based fibrinolysis if PCI unavailable
Step 4 — Symptom relief
- Glyceryl trinitrate · s.l./i.v.
400–800 mcg SL or IV infusion PRN
- Morphine · i.v.
2–4 mg IV if severe pain
References
- • ESC Guidelines — Acute coronary syndromes (2023)
Updated: Июль 2026