Guidelines of the Spanish Society of Cardiology for Unstable Angina/Myocardial Infarction with no ST elevation

This paper up-dates the Clinical Guidelines for Unstable Angina/Non Q wave Myocardial infarction of the Spanish Society of Cardiology. Due to the incr eased efficacy of adequate management in the early phases, it has been cons idered necessary to include recommendations for the pre Hospital and Emerge ncy department phase. Prehospital management. Patients with thoracic pain compatible with myocard ial ischemia should be transferred to Hospital as quickly as possible and a n ECG tracing performed. Initial management includes rest, sublingual nitro glycerin and aspirin. In the Emergency department. Immediate clinical attention and accessibility to a defibrillator should be available. if ECG tracing discloses ST elevat ion reperfusion strategy is to be implemented immediately, If no ST elevati on is present, the probability of myocardial ischemia and risk factor evalu ation is essential for adequate management, A simplified risk stratificatio n classification is presented, that also determines the most adequate site for admission: Coronary Care Unit if high risk factors are present, Cardiol ogy ward for the intermediate risk patient and ambulatory treatment if low risk. Management in Coronary Care Unit. Includes routine ECG monitoring and analg esia. Antithrombotic and anti ischemic treatment include new indication for GP IIb-IIIa and Low molecular weight heparins. Coronary arteriography and revascularisation are recommended, if refractary or recurrent angina, left ventricles dysfunction or other complications ar e present. Management in the ward is based on adequate chronic medical treatment, risk stratification, and secondary prevention strategy. Coronary arteriography before discharge must be considered in the light of the result of non-invas ive tests.