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Department of Paediatrics Division of Cardiology Faculty of Medicine Chiang Mai University Hospital 110 Intavaroros Road Chiang Mai 50200 Thailand Sittiwangkul R, MD Associate Professor Pongprot Y, MD Associate Professor Silvilairat S, MD Asssistant Professor Phornphutkul C, MD Professor Correspondence to: Dr Rekwan Sittiwangkul Tel: 66 ; 53 945 419 Fax: 66 ; 53 946 461 Email: rsittiwa mail.med.cmu.ac.th and motrin.

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C.Percutaneous coronary intervention PCI ; 1.PCI is preferable to thrombolytic therapy if per formed in a timely fashion by individuals skilled in the procedure. Coronary angioplasty provides higher rates of TIMI-3 flow than thrombolytics and is associated with lower rates of reocclusion and postinfarction ischemia and intracerebral bleed than fibrinolytic therapy. 2.Patients at high risk for mortality or severe LV dysfunction with signs of shock, pulmonary con gestion, heart rate 100 bpm, and SBP 100 mm Hg should be sent to facilities capable of perform ing cardiac catheterization and rapid revascularization. When available within 90 min utes, PCI is recommended for all patients, particu larly those who have a high risk of bleeding with fibrinolytic therapy. XII.Management of Non-ST Segment Myocardial Infarction and Unstable Angina A.Anti-ischemic therapy 1.Once unstable angina or non-ST-segment elevation MI has been identified, standard anti-ischemic treatments should be initiated. 2.Oxygen is indicated for patients with hypoxemia, cyanosis, or respiratory distress. Oxygen should be administered for at least the initial acute phase in all patients and longer in patients with congestive heart failure or a docu mented oxygen saturation of less than 92%. 3.Nitrates. Patients with ongoing chest pain should be given a 0.4-mg tablet of nitroglycerin NitroQuick, Nitrostat ; sublingually every 5 min utes for a total of three tablets in 15 minutes. If angina persists, continuous intravenous infu sion of nitroglycerin starting at 10 micro grams min should be instituted. Adjustments to 100 to 150 micrograms min may be made as.

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