Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x: Difference between revisions
(/* 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT){{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges...) |
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*2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid21545940">{{cite journal| author=Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM et al.| title=2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 19 | pages= e215-367 | pmid=21545940 | doi=10.1016/j.jacc.2011.02.011 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21545940 }} </ref> | |||
*The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref> | *The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref> | ||
Revision as of 15:35, 6 November 2012
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
Special Groups |
Diagnosis |
Laboratory Findings |
Treatment |
Antitplatelet Therapy |
Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
Mechanical Reperfusion |
Discharge Care |
Case Studies |
Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x On the Web |
FDA on Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x |
CDC onUnstable angina / non ST elevation myocardial infarction cardiovascular syndrome x |
Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x in the news |
Blogs on Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Smita Kohli, M.D.
Overview of Cardiovascular Syndrome X in UA / NSTEMI
- Cardiovascular syndrome X refers to patients with angina or angina-like discomfort with exercise, ST-segment depression on exercise testing, and normal or nonobstructed coronary arteries on angiography.
- This entity should be differentiated from the metabolic syndrome X or metabolic syndrome, which describes patients with insulin resistance, hyperinsulinemia, dyslipidemia, hypertension, and abdominal obesity.
- It also should be differentiated from noncardiac chest pain.
- Syndrome X is more common in women than in men.
- The cause of the discomfort and ST-segment depression in patients with syndrome X is not well understood. The most frequently proposed causes are:
- impaired endothelium dependent arterial vasodilatation with decreased nitric oxide production,
- impaired microvascular dilation (non–endothelium-dependent),
- increased sensitivity to sympathetic stimulation, or
- coronary vasoconstriction in response to exercise.
- Recently, there is increasing evidence that these patients frequently also have an increased responsiveness to pain and an abnormality in pain perception.
Diagnosis
- The diagnosis of syndrome X is suggested by the triad of:
- This can be confirmed by provocative coronary angiographic testing with acetylcholine for coronary endothelium-dependent function and adenosine for non–endothelium-dependent microvascular function.
- Other non-cardiac causes of chest pain,such as esophageal dysmotility, fibromyalgia, and costochondritis, should be ruled out.
Treatment
- It is recommended that patients be reassured of the excellent intermediate-term prognosis and treated with long-acting nitrates.
- If the patient continues to have episodes of chest pain, a calcium channel blocker or beta blocker can be started.
- Beta blockers and calcium channel blockers have been found to be effective in reducing the number of episodes of chest discomfort. Nitrates can be helful in half of the patients.
- Imipramine 50 mg daily has been successful in some chronic pain syndromes, including syndrome X, reducing the frequency of chest pain by 50%[1].
- Transcutaneous electrical nerve stimulation and spinal cord stimulation can offer good pain control.
- Statin therapy and exercise training have improved exercise capacity, endothelial function, and symptoms in some studies.
2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)[2]
Cardiovascular “Syndrome X” (DO NOT EDIT)[2]
Class I |
"1. Medical therapy with nitrates, beta blockers, and calcium channel blockers, alone or in combination is recommended in patients with cardiovascular syndrome X. (Level of Evidence: B)" |
"2. Risk factor reduction is recommended in patients with cardiovascular syndrome X. (Level of Evidence: B)" |
Class III |
"1. Medical therapy with nitrates, beta blockers, and calcium channel blockers for patients with non cardiac chest pain is not recommended. (Level of Evidence: C)" |
Class IIb |
"1. Intracoronary ultrasound to assess the extent of atherosclerosis and rule out missed obstructive lesions may be considered in patients with syndrome X. (Level of Evidence: B)" |
"2. If no ECGs during chest pain are available and coronary spasm cannot be ruled out, coronary angiography and provocative testing with acetylcholine, adenosine, or methacholine and 24 h ambulatory ECG may be considered. (Level of Evidence: C)" |
"3. If coronary angiography is performed and does not reveal a cause of chest discomfort, and if syndrome X is suspected, invasive physiological assessment (i.e., coronary flow reserve measurement) may be considered. (Level of Evidence: C)" |
"4. Imipramine or aminophylline may be considered in patients with syndrome X for continued pain despite implementation of Class I measures. (Level of Evidence: C)" |
"5. Transcutaneous electrical nerve stimulation and spinal cord stimulation for continued pain despite the implementation of Class I measures may be considered for patients with syndrome X. (Level of Evidence: B)" |
See Also
Sources
- 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)[3]
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [4]
References
- ↑ Cannon RO, Quyyumi AA, Mincemoyer R; et al. (1994). "Imipramine in patients with chest pain despite normal coronary angiograms". N. Engl. J. Med. 330 (20): 1411–7. PMID 8159194. Unknown parameter
|month=
ignored (help) - ↑ 2.0 2.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE; et al. (2011). "2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 123 (18): e426–579. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888.
- ↑ Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM; et al. (2011). "2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons". J Am Coll Cardiol. 57 (19): e215–367. doi:10.1016/j.jacc.2011.02.011. PMID 21545940.
- ↑ Anderson JL, Adams CD, Antman EM; et al. (2007). "ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
|month=
ignored (help)