62 years old malay lady with typical chest pain and vomiting.

62 years old Malay Lady with known case of hypertension and diabetes mellitus for 10 years under Hospital X follow up presented with severe chest pain for 1 hour prior to presentation to the casualty. The pain is centrally located, lasted about 15 minutes, Crushing in nature, not radiating and associated with one episode of vomiting.

BP: 146/78mmHg

PR: 78 b.p.m

SPO2: 98%

Glucose: 23.2 mmol/l

Urea: 6.8mmol/L

Na: 134.5 mmol/L

K: 4.6 mmol/L

Cl: 96.3 mmol/L

CKMB: 48 U/L

ECG: ST depression on lead V1 and V2

Questions

1) What is your complete diagnosis?

2) Outline your principal of management

3) What are the MOA for Beta blocker

4) What are the contraindication for Beta blocker

for answer to this questions, click [here]

UFH Heparin for NSTEMI

Image taken from this site [link]

1ml heparin=5000 U,

Give 5000 U stat, followed with infusion

12500 U (2.5ml) dilute with normal saline to make 50ml.

Infuse 1000 U/hr

=4ml/hr

*Infusion rate adjusted through monitoring of aPTT (1.5-2.5X control)

*aPTT 6 hourly

* Maintained for 2-5day.