Medical management of MI

Anti-Ischemic Therapy

Sublingual nitroglycerin followed by IV nitroglycerin for persistent chest pain or to lower BP
Morphine sulphate for chest pain not relieved by NTG and /or relief of symptoms of LV failure
Beta Blockers should be administered in patients with presumed ACS unless contraindications exist such as severe bradycardia, severe hypotension or severe asthma.
A non-dihydropyridine calcium channel blocker such as verapamil or diltiazem can be used if beta blockers are contraindicated
An ace inhibitor should be used if there is LV dysfunction, inadequate BP control on the above agents or the patient is diabetic.

Anti-Platelet Agents

Aspirin should be used in all patients unless a they are allergic or there is major GI intolerance
In that case clopidogrel (Plavix) should be used.
Clopidogrel indications
Treatment with GP IIb/IIIa agents along with aspirin, clopidogrel and heparin should be considered in :
ongoing ischemia
other high risk features
for patients who will receive an early invasive strategy to include cardiac cath or PCI
Note: abciximab (Reopro) only indicated prior to PC.