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I am more confident in providing BP measurement services for the patients who visit the Pharmacy after studying this module

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Different therapeutic approaches are used for the treatment of ACS, as platelet-rich clots are found in patients with UA and NSTEMI, while fibrin-rich clots are found in patients with STEMI.

In UA and NSTEMI, the goal of antithrombotic therapy is to prevent further thrombosis and allow the process of endogenous fibrinolysis (the enzymatic breakdown of the fibrin in blood clots) to dissolve the thrombus and reduce the degree of arterial narrowing. Surgical revascularisation is frequently used to increase blood flow and prevent further occlusion or recurrent ischaemia.

In contrast, with STEMI, the artery is usually totally occluded (obstructed), and immediate thrombolytic medicines or catheter-based reperfusion is the initial approach. The goal of these treatment options is to obtain normal coronary blood flow. Other therapies, such as anti-ischaemic and lipid-lowering therapies, are used in all cases in the patient’s long-term treatment plan.

UA and NSTEMI are managed in a similar way, with treatment providing supportive care and pain relief during the acute attack, with the aim of preventing further cardiac events and death. The need for long-term treatment should also be assessed, as most patients will require standard angina t

The aim of treatment in AF is to restore satisfactory circulation, relieve symptoms and prevent further episodes of poor circulation and distress. This can be done by either controlling the ventricular rate – known as ‘rate control’ – or attempting to restore and maintain sinus rhythm – called ‘rhythm control’.

NICE recommends rate control as the first-line strategy for people with AF, offering either a standard beta-blocker – although not sotalol as it may prolong the QT interval and cause life-threatening ventricular arrhythmias – or a rate-limiting calcium channel blocker – such as diltiazem and verapamil.

In addition, a possible third option could be to stop the patient’s current beta-blocker and administer intravenous esmolol, a relatively cardioselective beta-blocker with a very short duration of action, or even metoprolol given its short half-life. If Mr Carlton is in distress he should be treated as soon as possible – via an intravenous route.