ABSTRACT
The acute coronary syndrome includes ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina. All patients following an acute coronary syndrome or who have undergone percutaneous coronary intervention should receive clopidogrel. Sublingual or intravenous organic nitrates can be used to reduce chest pain provided that the patient is not hypotensive. Early administration of a beta-blocker reduces infarct size and life-threatening arrhythmias. Angiotensin-converting-enzyme inhibitors inhibitors or the angiotensin-II-receptor antagonist valsartan should also be administered within 24 hours after an ST-elevation infarction or for those with left bundle branch block. Most benefit is due to improvement in left ventricular function. Streptokinase is the most commonly used thrombolytic agent in the UK. Aspirin 300 mg should be given to all patients unless there are clear contraindications. Bleeding, symptomatic hypotension and allergic reactions are the most common and serious reactions associated with streptokinase therapy.
