Unstable angina non ST elevation myocardial infarction: Difference between revisions

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{{Infobox_Disease
__NOTOC__
| Name          = Unstable angina pectoris
{| class="infobox" style="float:right;"
| Image          = Coronary thrombosis 3.jpg
|-
| Caption        = Plaque rupture in a coronary artery at arrows yielding obstructive thrombus in red.  <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>
| [[File:Siren.gif|30px|link=Unstable angina/ NSTEMI resident survival guide]]|| <br> || <br>
| DiseasesDB    = 8695
| [[Unstable angina/ NSTEMI resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
| ICD10          = {{ICD10|I|20||i|20}}
|}
| ICD9          = {{ICD9|413}}  
{{Unstable angina / NSTEMI}}
| ICDO          =  
 
| OMIM          =
'''For patient information, click [[Unstable angina / non ST elevation myocardial infarction (patient information)|here]]'''
| MedlinePlus    =  
 
| eMedicineSubj  = med
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; Smita Kohli, M.D.; {{NMG}}; Bryan Piccirillo, B.S., M.D.
| eMedicineTopic = 133
 
| MeshID        = D000787
{{SK}} Angina at rest; rest angina; progressive angina; crescendo angina; accelerating angina; new-onset angina; pre-infarction angina; unstable angina pectoris; UAP; UA; new-onset angina; angina - unstable
}}
 
{{Search infobox}}
==[[Unstable angina / non ST elevation myocardial infarction overview | Overview]]==
 
==[[Unstable angina / non ST elevation myocardial infarction classification | Classification]]==


{{CMG}}
==[[Unstable angina / non ST elevation myocardial infarction pathophysiology| Pathophysiology]]==
__NOTOC__
[[Unstable angina pathophysiology|Unstable Angina]] | [[Non ST elevation myocardial infarction pathophysiology|Non-ST Elevation Myocardial Infarction]]
'''Associate Editor-In-Chief:''' {{CZ}}
 
==[[Chest pain differential diagnosis|Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders]]==
 
==[[Unstable angina / non ST elevation myocardial infarction epidemiology and demographics | Epidemiology and Demographics]]==
 
==[[Unstable angina / non ST elevation myocardial infarction risk stratification and prognosis|Risk Stratification]]==
 
==[[Unstable angina / non ST elevation myocardial infarction natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
==Special Groups==
[[Unstable angina / non ST elevation myocardial infarction women | Women]]  |  [[Unstable angina / non ST elevation myocardial infarction diabetic patients | Diabetic Patients]]  |  [[Unstable angina / non ST elevation myocardial infarction post CABG patients | Post CABG Patients]]  |  [[Unstable angina / non ST elevation myocardial infarction elderly | Elderly]]  |  [[Unstable angina / non ST elevation myocardial infarction chronic kidney disease | Chronic Kidney Disease]]  |  [[Unstable angina / non ST elevation myocardial infarction drug and substance abusers | Substance Abusers]]  |  [[Unstable angina / non ST elevation myocardial infarction prinzmetal's angina | Prinzmetal's Angina]]  |  [[Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x | Cardiovascular Syndrome X]]
 
==Diagnosis==
[[Unstable angina / non ST elevation myocardial infarction symptoms|History and Symptoms]] | [[Unstable angina / non ST elevation myocardial infarction physical examination|Physical Examination]] | [[Unstable angina / non ST elevation myocardial infarction blood studies|Blood Studies]] | [[Unstable angina / non ST elevation myocardial infarction biomarkers |Biomarkers]] | [[Unstable angina / non ST elevation myocardial infarction electrocardiogram|Electrocardiogram]] | [[Unstable angina / non ST elevation myocardial infarction chest x-ray|Chest X Ray]] | [[Unstable angina / non ST elevation myocardial infarction echocardiogram |Echocardiography]] | [[Unstable angina / non ST elevation myocardial infarction coronary angiography| Coronary Angiography]]


{{Editor Join}}
==[[Unstable angina treatment|Treatment]]==


'''Synonyms and related keywords''': angina at rest, rest angina, progressive angina, crescendo angina, accelerating angina, new-onset angina, pre-infarction angina, unstable angina pectoris, UAP, UA <ref>Ambrose JA, Winters SL, Stern A, et al: Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 1985 Mar; 5(3): 609-16. PMID 3973257</ref> <ref>Crea F, Biasucci LM, Buffon A, Liuzzo G, Monaco C, Caligiuri G, et al. Role of inflammation in the pathogenesis of unstable coronary artery disease. Am J Cardiol 1997; 80: 10-6E. PMID 9296463</ref> <ref>Biasucci LM, Colizzi C, Rizzello V, Vitrella G, Crea F, Liuzzo G. Role of inflammation in the pathogenesis of unstable coronary artery diseases. Scand J Clin Lab Invest Suppl 1999; 230: 12-22 PMID 10389197</ref> <ref>Asher CR, Topol EJ, Moliterno DJ, et al: Insights into the pathophysiology of atherosclerosis and prognosis of black Americans with acute coronary syndromes. Am Heart J 1999 Dec; 138(6 Pt 1): 1073-81 PMID 10577437</ref> <ref>Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ. Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol. 2005 Sep 20;46(6):937-54. PMID 16168274</ref> <ref>Braunwald E: Unstable angina: A classification. Circulation 1989; 80: 410-414. PMID 2752565</ref> <ref>Scirica BM, Cannon CP, McCabe CH, et al: Prognosis in the Thrombolysis in Myocardial Ischemia III Registry according to the Braunwald unstable angina pectoris classification. Am J Cardiol 2002; 90: 821-826.PMID 12372567</ref> <ref>Davies MJ: The composition of coronary-artery plaques. N Engl J Med  1997; 336:1312-1314. PMID 9113937</ref> <ref>Kennon S, Price CP, Mills PG, et al: The central role of platelet activation in determining the severity of acute coronary syndromes. Heart 2003; 89:1253-1254. PMID 12975438</ref> <ref name="Anderson"> Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. 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).'' Circulation 2007 116: e148 – e304. PMID 17679616</ref> <ref name="Anderson2"> Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. Correction of 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).'' J Am Coll Cardiol. 2008 Mar 4; 51(9): 974. PMID 17692738 </ref> <ref>Kaski JC: Rapid coronary artery disease progression and angiographic stenosis morphology. Ital Heart J 2000; 1:21-25. PMID 10868918</ref> <ref>van't Hof AW, de Vries ST, Dambrink JH, et al: A comparison of two invasive strategies in patients with non-ST elevation acute coronary syndromes: Results  of the Early or Late Intervention in unStable Angina (ELISA) pilot study. 2b/3a upstream therapy and acute coronary syndromes. Eur Heart J 2003; 24:1401-1405. PMID 12909068</ref> <ref>Ryan JW, Peterson ED, Chen AY, et al: Optimal timing of intervention in  non-ST-segment elevation acute coronary syndromes: Insights from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with  Early implementation of the ACC/AHA guidelines) Registry. Circulation  2005; 112:3049-3057. PMID 16275863</ref> <ref>Prinzmetal M, Kennamer R, Merliss R, et al: A variant form of angina pectoris. Am J Med 1959; 27:375. PMID 14434946</ref> <ref>Roe MT, Harrington RA, Prosper DM, et al: Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease. The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators. ''Circulation'' 2000; 102:1101-1106. PMID 10973837</ref> <ref>Lindahl B, Diderholm E, Lagerqvist B, et al: Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: A FRISC II substudy. J Am Coll Cardiol 2001; 38:979-986. PMID 11583868</ref> <ref>Roffi M, Chew DP, Mukherjee D, et al: Platelet glycoprotein IIb/IIIa inhibitors  reduce mortality in diabetic patients with non-ST-segment-elevation acute coronary syndromes. Circulation 2001; 104:2767-2771. PMID 11733392</ref> <ref>Westerhout CM, Fu Y, Lauer MS, et al: Short- and long-term risk stratification in acute coronary syndromes: The added value of quantitative ST-segment depression and multiple biomarkers. ''J Am Coll Cardiol'' 2006; 48:939-947. PMID 16949483</ref> <ref>Heeschen C, Hamm CW, Bruemmer J, Simoons ML, for the Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial (CAPTURE) Investigators : Predictive value of C-reactive protein and troponin T in patients with unstable angina: A comparative analysis. ''J Am Coll Cardiol'' 2000; 35:1535-1542. PMID 10807457</ref> <ref>Lindmark E, Diderholm E, Wallentin L, Siegbahn A: Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease: Effects of an early invasive or noninvasive strategy. ''JAMA'' 2001; 286:2107-2113. PMID 11694151</ref> <ref>Sherman CT, Litvack F, Grundfest W, Lee M, Hickey A, Chaux A, Kass R, Blanche C, Matloff J, Morgenstern L, Ganz W, Swan HJC, Forrester J (1986) Coronary angioscopy in patients with unstable angina pectoris. PMID 3489893</ref> <ref>Zairis MN, Papadaki OA, Manousakis SJ, et al: C-reactive protein and multiple complex coronary artery plaques in patients with primary unstable angina. Atherosclerosis  2002; 164:355-359. PMID 12204808</ref> <ref>Mueller C, Neumann FJ, Roskamm H, et al: Women do have an improved long-term outcome after non-ST-elevation acute coronary syndromes treated very early and predominantly with percutaneous coronary intervention: A prospective study in 1450 consecutive patients. ''J Am Coll Cardiol'' 2002; 40:245-250. PMID 12106927</ref> <ref>Brennan ML, Penn MS, Van Lente F, et al: Prognostic value of myeloperoxidase in patients with chest pain. ''N Engl J Med'' 2003; 349:1595-1604. PMID 14573731</ref> <ref>Buffon A, Biasucci LM, Liuzzo G, et al: Widespread coronary inflammation in unstable angina. ''N Engl J Med'' 2002; 347:5-12. 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PMID 12874182 </ref> <ref>Peters RJ, Mehta SR, Fox KA, et al: Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: Observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. ''Circulation''  2003; 108:1682-1687. PMID 14504182</ref> <ref>Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators : Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. ''N Engl J Med'' 2001; 345:494-502. PMID 11519503 </ref> <ref>Yusuf S, Mehta SR, Zhao F, et al: Early and late effects of clopidogrel in patients with acute coronary syndromes. ''Circulation'' 2003; 107:966-972. PMID 12600908</ref> <ref>Montalescot G, Sideris G, Meuleman C, et al: A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: The ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation, and Ongoing Necrosis) trial. ''J Am Coll Cardiol'' 2006; 48:931-938. PMID 16949482 </ref> <ref>Neumann FJ, Kastrati A, Pogatsa-Murray G, et al: Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: A randomized controlled trial. ''JAMA'' 2003; 290:1593-1599. PMID 14506118</ref> <ref>Patti G, Colonna G, Pasceri V, et al: Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: Results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study. ''Circulation'' 2005; 111:2099-2106. PMID 15750189</ref> <ref>Wiviott SD, Antman EM, Gibson CM, et al: Evaluation of prasugrel compared with clopidogrel in patients with acute coronary syndromes: Design and rationale for the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38). ''Am Heart J''  2006; 152:627-635. PMID 16996826 </ref> <ref>Giugliano RP, Newby LK, Harrington RA, et al: The early glycoprotein IIb/IIIa inhibition in non-ST-segment elevation acute coronary syndrome (EARLY ACS) trial: A randomized placebo-controlled trial evaluating the clinical benefits of early front-loaded eptifibatide in the treatment of patients with non-ST-segment elevation acute coronary syndrome—study design and rationale. ''Am Heart J'' 2005; 149:994-1002. PMID 15976780</ref> <ref>Eikelboom JW, Anand SS, Malmberg K, et al: Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: A meta-analysis. ''Lancet'' 2000; 355:1936-1942. PMID 10859038 </ref> <ref>Rich JD, Maraganore JM, Young E, et al: Heparin resistance in acute coronary syndromes. ''J Thromb Thrombolysis'' 2007; 23:93-100. PMID 17221324</ref> <ref>Warkentin TE, Kelton JG: Temporal aspects of heparin-induced thrombocytopenia. ''N Engl J Med'' 2001; 344:1286-1292 PMID 11320387</ref> <ref>Petersen JL, Mahaffey KW, Hasselblad V, et al: Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-segment elevation acute coronary syndromes: A systematic overview. ''JAMA'' 2004; 292:89-96. PMID 15238596 </ref> <ref>Ferguson JJ, Califf RM, Antman EM, et al: Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: Primary results of the SYNERGY randomized trial. ''JAMA'' 2004; 292:45-54. PMID 15238590 </ref> <ref>Michalis LK, Katsouras CS, Papamichael N, et al: Enoxaparin versus tinzaparin in non-ST-segment elevation acute coronary syndromes: The EVET trial. ''Am Heart J'' 2003; 146:304-310. PMID 12891200</ref> <ref>Yusuf S, Mehta SR, Chrolavicius S, et al: Comparison of fondaparinux and enoxaparin in acute coronary syndromes. ''N Engl J Med'' 2006; 354:1464-1476. PMID 16537663 </ref> <ref>Stone GW, McLaurin BT, Cox DA, et al: Bivalirudin for patients with acute coronary syndromes. ''N Engl J Med'' 2006; 355:2203-2216. PMID 17124018 </ref> <ref>FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators : Invasive compared with non-invasive treatment in unstable coronary artery disease: FRISC II prospective randomised multicentre study. ''Lancet'' 1999; 354:708-715. PMID 10475181</ref> <ref>Fox KA, Goodman SG, Klein W, et al: Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE). ''Eur Heart J'' 2002; 23:1177-1189. PMID 12127920</ref> <ref>Lagerqvist B, Husted S, Kontny F, et al: 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: A follow-up study. ''Lancet'' 2006; 368:998-1004 PMID 16980115</ref> <ref>Mahoney EM, Jurkovitz CT, Chu H, et al: Cost and cost-effectiveness of an early invasive versus conservative strategy for the treatment of unstable angina and non-ST elevation myocardial infarction. ''JAMA'' 2002; 288:1851-1858. PMID 12377083</ref> <ref>Fox KA, Poole-Wilson PA, Henderson RA, et al: Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: The British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. ''Lancet'' 2002; 360:743-751. PMID 12241831</ref> <ref>Fox KAA, Poole-Wilson P, Clayton TC, et al: 5-Year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: The British Heart Foundation RITA 3 randomised trial. ''Lancet'' 2005; 366:914-920. PMID 16154018 </ref> <ref>van't Hof AW, de Vries ST, Dambrink JH, et al: A comparison of two invasive strategies in patients with non-ST elevation acute coronary syndromes: Results of the Early or Late Intervention in unStable Angina (ELISA) pilot study. 2b/3a upstream therapy and acute coronary syndromes. ''Eur Heart J'' 2003; 24:1401-1405. PMID 12909068 </ref> <ref>McCullough PA, Gibson CM, DiBattiste PM, et al: Timing of angiography and revascularization in acute coronary syndromes: An analysis from the TACTICS-TIMI 18 trial. ''J Interv Cardiol'' 2004;81-86. PMID 15104769</ref> <ref>Ryan JW, Peterson ED, Chen AY, et al: Optimal timing of intervention in non-ST-segment elevation acute coronary syndromes: Insights from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Registry. ''Circulation'' 2005; 112:3049-3057. PMID 16275863</ref> <ref>Tonkin AM, Colquhoun D, Emberson J, et al: Effects of pravastatin in 3260 patients with unstable angina: Results from the LIPID study. ''Lancet'' 2000; 356: 1871-1875.  PMID 11130382 </ref> <ref>Scirica BM, Cannon CP, Gibson CM, et al: Assessing the effect of publication of clinical guidelines on the management of unstable angina and non-ST-elevation myocardial infarction in the TIMI III (1990-93) and the GUARANTEE (1995-96) registries. ''Crit Path Cardiol'' 2002; 1:151-160. PMID 18340298</ref> <ref>Giugliano RP, Lloyd-Jones DM, Camargo Jr. CA, et al: Association of unstable angina guideline care with improved survival.  ''Arch Intern Med'' 2000; 160:1775-1780. PMID 10871970 </ref> <ref>Roe MT, Peterson ED, Newby LK, et al: The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. ''Am Heart J'' 2006; 151:1205-1213. 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Coronary vasospasm-induced acute coronary syndrome complicated by life-threatening cardia arrhythmias in patients without hemodynamically significant coronary artery disease. ''Int J Cardiol'' 2007; 117:37-44. PMID 16844245</ref> <ref>Yuksel UD, Celik T, Iyisoy A, et al:. Polymorphic ventricular tachycardia induced by coronary vasospasm: A malignant case of variant angina. Int J Cardiol, 2006. E-pubahead of print, Nov. 22, 2006. PMID 17125857 </ref> <ref>Kawano H, Motoyama T, Yasue H, et al: Endothelial function fluctuates with diurnal variation in the frequency of ischemic episodes in patients with variant angina. ''J Am Coll Cardiol'' 2002; 40:266-270. PMID 12106930</ref> <ref>Matsuguchi T, Araki H, Nakamura N, et al: Prevention of vasospastic angina by alcohol ingestion: Report of 2 cases. ''Angiology'' 1988; 39:394-400. PMID 3364807</ref> <ref>Raxwal V, Gupta K: Images in cardiovascular medicine. Coronary artery spasm. ''Circulation'' 2006; 113:e689-e690. 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PMID 8809510</ref> <ref>Hirano Y, Ueharfa H, Nakamura H, et al: Diagnosis of vasospastic angina: Comparison of hyperventilation and cold-pressor stress echocardiography, and coronary angiography with intracoronary injection of acetylcholine. ''Int J Cardiol'' 2007; 116:331-337. PMID 16890307</ref> <ref>Nakao K, Ohgushi M, Yoshimura M, et al: Hyperventilation as a specific test for diagnosis of coronary artery spasm. ''Am J Cardiol'' 1997; 80:545-549. PMID 9294979</ref> <ref>Antman E, Muller J, Goldberg S, et al: Nifedepine therapy for coronary artery spasm. Experience in 127 patients.  ''N Engl J Med''  1980; 302:1269-1273. PMID 6767986</ref> <ref>De Cesare N, Cozzi S, Apostolo A, et al: Facilitation of coronary spasm by propranolol in Prinzmetal's angina: Fact or unproven extrapolation?. ''Coron Artery Dis'' 1994; 5:323-330. PMID 8044344</ref> <ref>Tzivoni D, Keren A, Benhorin J, et al: Prazosin therapy for refractory variant angina.''Am Heart J'' 1983; 105:262-266. PMID 6823808 </ref> <ref>Kaski JC: Management of vasospastic angina—role of nicorandil. ''Cardiovasc Drugs Ther 9 Suppl'' 1995; 2:221-227. PMID 7647026</ref> <ref>Kawano H, Motoyama T, Hirai N, et al: Estradiol supplementation suppresses hyperventilation-induced attacks in postmenopausal women with variant angina. ''J Am Coll Cardiol'' 2001; 37:735-740. PMID 11693745</ref> <ref>Tanabe Y, Itoh E, Suzuki K, et al: Limited role of coronary angioplasty and stenting in coronary spastic angina with organic stenosis. ''J Am Coll Cardiol'' 2002; 39:1120-1126. PMID 11923034 </ref> <ref>Meisel SR, Mazur A, Chetboun I, et al: Usefulness of implantable cardioverter-defibrillators in refractory variant angina pectoris complicated by ventricular fibrillation in patients with angiographically normal coronary arteries. ''Am J Cardiol'' 2002; 89:1114-1116. PMID 11988204</ref> <ref>Bory M, Pierron F, Panagides D, et al: Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. ''Eur Heart J'' 1996; 17:1015-1021. PMID 8809518</ref> <ref>Shimokawa H, Nagasawa K, Irie T, et al: Clinical characteristics and long-term prognosis of patients with variant angina. A comparative study between western and Japanese populations. ''Int J Cardiol'' 1998; 18:331-349. PMID 3129375</ref> <ref>Tashiro H, Shimokawa H, Koyanagi S, Takeshita A: Clinical characteristics of patients with spontaneous remission of variant angina. ''Jpn Circ J'' 1993; 57:117-122. PMID 8450595 </ref>
'''[[Unstable angina / non ST elevation myocardial infarction primary prevention|Primary Prevention]]'''


==[[Definition of Unstable Angina Pectoris|Definition]]==
'''Immediate Management:''' [[Unstable angina / non ST elevation myocardial infarction immediate management | Overview]] | [[Unstable angina / non ST elevation myocardial infarction oxygen therapy |Oxygen]] | [[Unstable angina / non ST elevation myocardial infarction nitrate therapy |Nitrates]] | [[Unstable angina / non ST elevation myocardial infarction analgesics | Analgesics]] | [[Unstable angina / non ST elevation myocardial infarction beta blockers | Beta Blockers]] | [[Unstable angina / non ST elevation myocardial infarction calcium channel blockers| Calcium Channel Blocker]] | [[Unstable angina / non ST elevation myocardial infarction inhibitors of RAS | Renin-Angiotensin-Aldosterone Inhibitors]]


==[[Unstable angina overview| Overview]]==
'''Antithrombin Therapy:''' [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy | Overview]] | [[Unstable angina / non ST elevation myocardial infarction unfractionated heparin therapy |Unfractionated Heparin]] | [[Unstable angina / non ST elevation myocardial infarction low molecular weight heparin therapy |Low Molecular Weight Heparin]] | [[Unstable angina / non ST elevation myocardial infarction direct thrombin inhibitors therapy |Direct Thrombin Inhibitors]] | [[Unstable angina / non ST elevation myocardial infarction factor Xa inhibitors therapy |Factor Xa Inhibitors]] | [[Unstable angina / non ST elevation myocardial infarction long term anticoagulation therapy |Long Term Anticoagulation]]


==[[Unstable angina epidemiology and demographics| Epidemiology and Demographics]]==
'''Antiplatelet Agents:''' [[Unstable angina/NSTEMI Antiplatelet therapy recommendations|Antiplatelet Therapy Recommendations]] | [[Unstable angina / non ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[Unstable angina / non ST elevation myocardial infarction thienopyridines|Thienopyridines]] | [[Unstable angina / non ST elevation myocardial infarction GPIIb/IIIa inhibitor|Glycoprotein IIb/IIIa Inhibitor]] |[[Unstable angina / non ST elevation myocardial infarction additional management considerations for antiplatelet and anticoagulant therapy | Additional Management Considerations]]


==[[Unstable angina pathophysiology & etiology|Pathophysiology and Etiology]]==
'''Mechanical Reperfusion:''' [[Unstable angina / non ST elevation myocardial infarction initial conservative versus initial invasive strategies | Initial Conservative Versus Initial Invasive Strategies]] | [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI‎ | PCI]] | [[Unstable angina / non ST elevation myocardial infarction recommendations for CABG | CABG]]


==[[Unstable angina diagnosis| Diagnosis]]==
'''Complications of Bleeding and Transfusion:''' [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion|Overview]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion incidence |Incidence]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion - definitions for bleeding complications |Definitions]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion - predictors and causes of bleeding |Predictors and Causes of Bleeding]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion - blood transfusions |Blood Transfusions]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion prognosis |Prognosis]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion prevention |Prevention]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion recommendations |Recommendations]]  


==[[Unstable angina differential diagnosis| Differential Diagnosis]]==
'''Discharge Care:''' [[Unstable angina / non ST elevation myocardial infarction medical regimen and use of medications | Medical Regimen]] | [[Unstable angina / non ST elevation myocardial infarction post-discharge follow-up | Post-Discharge Follow-Up]] | [[Unstable angina / non ST elevation myocardial infarction cardiac rehabilitation | Cardiac Rehabilitation]]


==[[Unstable angina risk stratification and prognosis| Risk Stratification and Prognosis]]==
'''Long-Term Medical Therapy and Secondary Prevention:''' [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention |Overview]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy|Convalescent and Long-Term Antiplatelet Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for beta blockers|Beta Blockers]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for inhibitors of the RAS|Inhibition Of The Renin-Angiotensin-Aldosterone System]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for nitroglycerin|Nitroglycerin Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for calcium channel blockers|Calcium Channel Blockers]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for warfarin therapy|Warfarin Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management|Lipid Management]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for blood pressure control|Blood Pressure Control]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for smoking cessation|Smoking Cessation]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for weight management|Weight Management]] | [[UA/NSTEMI long-term medical therapy and secondary prevention ACC/AHA guidelines for Physical Activity|Physical Activity]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for patient education|Patient Education]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for influenza|Influenza]] | [[UA/NSTEMI long-term medical therapy and secondary prevention ACC/AHA guidelines depression|Depression]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines nonsteroidal anti-inflammatory drugs|Nonsteroidal Anti-Inflammatory Drugs]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines hormone therapy|Hormone Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines antioxidant vitamins and folic acid|Antioxidant Vitamins and Folic Acid]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines quality care and outcomes|Quality Care and Outcomes]]


==[[Unstable angina treatment| Treatment]]==
'''[[Unstable angina / non ST elevation myocardial infarction cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]'''


==[[Unstable angina and complications of bleeding and transfusion|Complications of Bleeding and Transfusion]]==
'''[[Unstable angina / non ST elevation myocardial infarction future or investigational therapies|Future or Investigational Therapies]]'''


==References==
====Contraindicated medications====
{{Reflist|2}}
{{MedCondContrAbs|MedCond = Unstable angina|Dalteparin|Fingolimod|Levothyroxine}}


==See Also==
==Case Studies==
[[Unstable angina / non ST elevation myocardial infarction case study one|Case #1]]


* [[The Living Guidelines: UA/NSTEMI]]
==Related Chapters==
* [[Acute Coronary Syndrome risk stratification|Acute Coronary Syndrome Risk Stratification]]
* [[Chronic stable angina]]
* [[Chronic stable angina]]
* [[Non ST Elevation Myocardial Infarction]]
* [[Non ST Elevation Myocardial Infarction]]
* [[ST Elevation Myocardial Infarction]]
* [[ST Elevation Myocardial Infarction]]
* [[Coronary Heart Disease]]
* [[PCI]]


==External links==
==External Links==
* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack] - based on information of the [[Framingham Heart Study]], from the United States [[National Heart, Lung and Blood Institute]]
* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack] - based on information of the [[Framingham Heart Study]], from the United States [[National Heart, Lung and Blood Institute]]
* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack] - overview of resources from [[MedlinePlus]].
{{WikiDoc Help Menu}}
* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals] from the Heart and Stroke Foundation of Canada
{{WikiDoc Sources}}
* [http://www.regionalpci-stemi.org/index.html Regional PCI for STEMI Resource Center] - Evidence based online resource center for the development of regional PCI networks for acute STEMI
* [http://www.stemisystems.org/ STEMI Systems] - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
*[http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site] - Information and resources for preventing, recognizing and treating heart attack.
 
{{Circulatory system pathology}}
{{Electrocardiography}}
{{SIB}}


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Latest revision as of 20:57, 5 December 2022
Resident
Survival
Guide

Acute Coronary Syndrome Main Page

Unstable angina / NSTEMI Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Unstable Angina
Non-ST Elevation Myocardial Infarction

Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders

Epidemiology and Demographics

Risk Stratification

Natural History, Complications and Prognosis

Special Groups

Women
Heart Failure and Cardiogenic Shock
Perioperative NSTE-ACS Related to Noncardiac Surgery
Stress (Takotsubo) Cardiomyopathy
Diabetes Mellitus
Post CABG Patients
Older Adults
Chronic Kidney Disease
Angiographically Normal Coronary Arteries
Variant (Prinzmetal's) Angina
Substance Abuse
Cardiovascular "Syndrome X"

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Blood Studies
Biomarkers

Electrocardiogram

Chest X Ray

Echocardiography

Coronary Angiography

Treatment

Primary Prevention

Immediate Management

Anti-Ischemic and Analgesic Therapy

Cholesterol Management

Antitplatelet Therapy

Antiplatelet therapy recommendations
Aspirin
Thienopyridines
Glycoprotein IIb/IIIa Inhibitor

Anticoagulant 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

Initial Conservative Versus Initial Invasive Strategies
PCI
CABG

Complications of Bleeding and Transfusion

Discharge Care

Medical Regimen
Post-Discharge Follow-Up
Cardiac Rehabilitation

Long-Term Medical Therapy and Secondary Prevention

ICD implantation within 40 days of myocardial infarction

ICD within 90 days of revascularization

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Unstable angina non ST elevation myocardial infarction On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Smita Kohli, M.D.; Neil Gheewala, M.D. [3]; Bryan Piccirillo, B.S., M.D.

Synonyms and keywords: Angina at rest; rest angina; progressive angina; crescendo angina; accelerating angina; new-onset angina; pre-infarction angina; unstable angina pectoris; UAP; UA; new-onset angina; angina - unstable

Overview

Classification

Pathophysiology

Unstable Angina | Non-ST Elevation Myocardial Infarction

Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders

Epidemiology and Demographics

Risk Stratification

Natural History, Complications and Prognosis

Special Groups

Women | Diabetic Patients | Post CABG Patients | Elderly | Chronic Kidney Disease | Substance Abusers | Prinzmetal's Angina | Cardiovascular Syndrome X

Diagnosis

History and Symptoms | Physical Examination | Blood Studies | Biomarkers | Electrocardiogram | Chest X Ray | Echocardiography | Coronary Angiography

Treatment

Primary Prevention

Immediate Management: Overview | Oxygen | Nitrates | Analgesics | Beta Blockers | Calcium Channel Blocker | Renin-Angiotensin-Aldosterone Inhibitors

Antithrombin Therapy: Overview | Unfractionated Heparin | Low Molecular Weight Heparin | Direct Thrombin Inhibitors | Factor Xa Inhibitors | Long Term Anticoagulation

Antiplatelet Agents: Antiplatelet Therapy Recommendations | Aspirin | Thienopyridines | Glycoprotein IIb/IIIa Inhibitor | Additional Management Considerations

Mechanical Reperfusion: Initial Conservative Versus Initial Invasive Strategies | PCI | CABG

Complications of Bleeding and Transfusion: Overview | Incidence | Definitions | Predictors and Causes of Bleeding | Blood Transfusions | Prognosis | Prevention | Recommendations

Discharge Care: Medical Regimen | Post-Discharge Follow-Up | Cardiac Rehabilitation

Long-Term Medical Therapy and Secondary Prevention: Overview | Convalescent and Long-Term Antiplatelet Therapy | Beta Blockers | Inhibition Of The Renin-Angiotensin-Aldosterone System | Nitroglycerin Therapy | Calcium Channel Blockers | Warfarin Therapy | Lipid Management | Blood Pressure Control | Smoking Cessation | Weight Management | Physical Activity | Patient Education | Influenza | Depression | Nonsteroidal Anti-Inflammatory Drugs | Hormone Therapy | Antioxidant Vitamins and Folic Acid | Quality Care and Outcomes

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Contraindicated medications

Unstable angina is considered an absolute contraindication to the use of the following medications:

Case Studies

Case #1

Related Chapters

External Links

Template:WikiDoc Sources

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