Unstable angina / non ST elevation myocardial infarction drug and substance abusers
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Overview of Drug and Substance Abusers with UA / NSTEMI
ACC / AHA Guidelines (DO NOT EDIT) [1]
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Class I1. Administration of sublingual or intravenous NTG and intravenous or oral calcium antagonists is recommended for patients with ST segment elevation or depression that accompanies ischemic chest discomfort after cocaine use. (Level of Evidence: C) 2. Immediate coronary angiography, if possible, should be performed in patients with ischemic chest discomfort after cocaine use whose ST segments remain elevated after NTG and calcium antagonists; PCI is recommended if occlusive thrombus is detected. (Level of Evidence: C) 3. Fibrinolytic therapy is useful in patients with ischemic chest discomfort after cocaine use if ST segments remain elevated despite NTG and calcium antagonists, if there are no contraindications, and if coronary angiography is not possible. (Level of Evidence: C) Class IIa1. Administration of NTG or oral calcium channel blockers can be beneficial for patients with normal ECGs or minimal ST segment deviation suggestive of ischemia after cocaine use. (Level of Evidence: C) 2. Coronary angiography, if available, is probably recommended for patients with ischemic chest discomfort after cocaine use with ST-segment depression or isolated T wave changes not known to be previously present and who are unresponsive to NTG and calcium antagonists. (Level of Evidence: C) 3. Management of UA / NSTEMI patients with methamphetamine use similar to that of patients with cocaine use is reasonable. (Level of Evidence: C) Class IIb1. Administration of combined alpha and beta blocking agents (e.g., labetalol) may be reasonable for patients after cocaine use with hypertension (systolic blood pressure >150 mm Hg) or those with sinus tachycardia (pulse >100 bpm) provided that the patient has received a vasodilator, such as NTG or a calcium antagonist, within close temporal proximity (i.e., within the previous hour). (Level of Evidence: C) Class III1. Coronary angiography is not recommended in patients with chest pain after cocaine use without ST segment or T wave changes and with a negative stress test and cardiac biomarkers. (Level of Evidence: C) |
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See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 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
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