Patient handout

NSTEMI / NSTE-ACS (UA + NSTEMI)

PRODUCTION

1. Your condition

This handout is for nstemi / nste-acs (ua + nstemi). Your care team identified this based on: ischemic-pattern chest pain or anginal equivalent (acc/aha 2025 acs, class i).

Other reasons your team may use this plan: high-sensitivity troponin elevation in appropriate clinical context (esc 2023 0/1-h algorithm); dynamic ecg changes (st depression ≥0.5 mm or t-wave inversion) per acc/aha 2021 chest pain §4.3; new rest angina within 48 h or accelerating angina (acc/aha 2025 acs, high-risk feature).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162–325 mg load → 81 mg	PO chewed	load once → 81 mg daily lifelong	Universal — ACC/AHA 2025 Class I; ISIS-2 (Lancet 1988) 23% mortality reduction
ticagrelor	180 mg load → 90 mg BID	PO	BID for 12 mo	PLATO HR 0.84 vs clopidogrel (PMID 19717846); preferred upstream of anatomy per ISAR-REACT 5 design (PMID 31475799); ACC/AHA 2025 Class I
unfractionated_heparin	60 U/kg bolus (max 4000) → 12 U/kg/h infusion	IV	continuous; aPTT 1.5–2× control	Default for emergent invasive per ACC/AHA 2025 Class I; reversible

Plan: Acute antithrombotic regimen for NSTE-ACS — phenotype-stratified per ACC/AHA 2025 + ESC 2023

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent chest pain or anginal equivalent → ED for serial hsTn + ECG (ACC/AHA 2025)
BARC 2+ bleed → reassess DAPT — consider TWILIGHT PMID 31556978 (ASA d/c, ticagrelor mono) or MASTER DAPT PMID 34449185 (1-mo DAPT then SAPT) per HAS-BLED ≥3
K >5.5 on MRA → hold MRA first, consider patiromer/SZC
Cr rise >30% from discharge → reduce ACEi/ARB; reassess volume; route to ED if symptomatic AKI
NYHA worsening to III+ → expedite cardiology re-evaluation + echo (ACC/AHA 2025)
Symptomatic hypotension after BB up-titration → hold next dose, recheck in 1 week

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

GRACE >140 or refractory ischemia or hemodynamic / electrical instability per ACC/AHA 2025
GRACE 109–140, recurrent angina with dynamic ECG, EF<40, post-PCI/CABG, recent MI per ACC/AHA 2025
SBP <90 with end-organ hypoperfusion or lactate >2 in NSTE-ACS per ACC/AHA 2025(life-threatening)
New murmur, pulmonary edema, papillary muscle rupture, VSD, free-wall rupture per ACC/AHA 2025(life-threatening)
New persistent ST elevation during admission per ACC/AHA 2025 STEMI criteria(life-threatening)
Major bleeding (BARC 3+) on DAPT or triple therapy per BARC criteria 2011

5. Follow-up

Cardiac rehab (ACC/AHA 2025 Class I), the four foundational heart-failure medications optimisation, lipid recheck 4–8 wks, DAPT duration plan per PLATO / TWILIGHT, lifestyle, vaccinations

6. Sources

Guideline: 2025 ACC/AHA Guideline for ACS (Rao); ESC 2023 NSTE-ACS Guideline (Byrne, PMID 37622654); ACC/AHA 2021 Chest Pain Guideline (Gulati, PMID 34709879)