Acute Coronary Syndrome (ACS)

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Raigmore ED Acute Coronary Syndrome (ACS) Management Pathway - click here.

Rural ED Acute Coronary Syndrome (ACS) Management Pathway - click here.

Part 1 Acute Coronary Syndrome

*Patients self presenting:
Mon-Fri 08:30-17:00: A&E to contact Cath Lab immediately to discuss PPCI
Out with these hours: Assess for thrombolysis

Part 2 Acute Coronary Syndrome

 

Criteria for Thrombolysis

Thrombolysis administration

Tenecteplase (TNK) dosing regimen

 

Age < 75 yrs

Age ≥ 75 yrs

Weight (kg)

TNK (units)

TNK (mg)

Vol (ml)

TNK (units)

TNK (mg)

Vol (ml)

< 60

6,000

30

6

3,000

15

3

60 - < 70

7,000

35

7

3,500

17.5

3.5

70 - < 80

8,000

40

8

4,000

20

4

80 - < 90

9,000

45

9

4,500

22.5

4.5

≥ 90

10,000

50

10

5,000

25

5

Unfractionated heparin i.v. infusion (only if eGFR < 15)
Following i.v. UFH bolus, start i.v. UFH infusion of 12 units per kg, up to a maximum of 1,000 units/h for 24 to 48 hours. Target aPTT: 50-70 s, or 1.5 to 2.0 times control at 3, 6, 12 and 24 h

Early Rule Out Pathway for Acute MI
Glossary
Abbreviation Meaning
GTN Glyceryl trinitrate 
ECG Electrocardiogram
CCU Coronary care unit
STEMI ST-Elevation Myocardial Infarction
AV Atrioventricular block
SBP Systolic blood pressure
DBP Diastolic blood pressure
LBBB Left bundle branch block
eGFR Estimated glomerular filtration rate
DOAC Direct oral anticoagulants
UFH Unfractionated heparin
aPTT Activated partial thromboplastin time
PCI Percutaneous Coronary Intervention 
Editorial Information

Last reviewed: 13 June 2019

Next review: 13 June 2021

Author(s): Department of Cardiology

Version: 8

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Consultant Cardiologist and Clinical Lead

Document Id: TAM135