For the immediate relief of ischemic symptoms, sublingua lNTG may be followed by intravenous administration. If the patient’s symptoms are not relieved immediately by NTG or if acute pulmonary congestion or severe agitation is present, morphine sulfate may be administered intravenously. Use of fibrinolytics is contraindicated in ACS patients unless they have acute ST-segment elevation, a true posterior MI, or presumed new left bundle branch block (Braunwald et al.,2002a).