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          =
| MedlinePlus    =
| eMedicineSubj  = med
| eMedicineTopic = 133
| MeshID        = D000787
}}
{{Search infobox}}


{{CMG}}
'''For patient information, click [[Unstable angina / non ST elevation myocardial infarction (patient information)|here]]'''
__NOTOC__
 
'''Associate Editor-In-Chief:''' {{CZ}}
{{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.


{{Editor Join}}
{{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


'''''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
==[[Unstable angina / non ST elevation myocardial infarction overview | Overview]]==


==Overview==
==[[Unstable angina / non ST elevation myocardial infarction classification | Classification]]==


===[[Unstable angina / non ST elevation myocardial infarction overview | Overview]]===
==[[Unstable angina / non ST elevation myocardial infarction pathophysiology| Pathophysiology]]==
[[Unstable angina pathophysiology|Unstable Angina]] | [[Non ST elevation myocardial infarction pathophysiology|Non-ST Elevation Myocardial Infarction]]


===[[Unstable angina / non ST elevation myocardial infarction epidemiology and demographics | Epidemiology and Demographics]]===
==[[Chest pain differential diagnosis|Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders]]==


==Pathophysiology and Etiology==
==[[Unstable angina / non ST elevation myocardial infarction epidemiology and demographics | Epidemiology and Demographics]]==


===[[Unstable angina pathophysiology & etiology|Pathophysiology and Etiology (UA)]]===
==[[Unstable angina / non ST elevation myocardial infarction risk stratification and prognosis|Risk Stratification]]==


===[[Non ST elevation myocardial infarction pathophysiology & etiology|Pathophysiology and Etiology (NSTEMI)]]===
==[[Unstable angina / non ST elevation myocardial infarction natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


==[[Unstable angina diagnosis| Diagnosis]]==
==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]]


===[[Unstable angina / non ST elevation myocardial infarction symptoms | Symptoms]]===
==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]]


===[[Chest pain|Differential diagnosis of chest pain]]===
==[[Unstable angina treatment|Treatment]]==


===[[Unstable angina / non ST elevation myocardial infarction physical examination | Physical Examination]]===
'''[[Unstable angina / non ST elevation myocardial infarction primary prevention|Primary Prevention]]'''


==[[Unstable angina risk stratification and prognosis| Risk Stratification and Prognosis]]==
'''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 treatment| Treatment]]==
'''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 / non ST elevation myocardial infarction immediate management | Immediate Management]]===
'''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 / non ST elevation myocardial infarction initial therapy | Initial Therapy]]===
'''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 / non ST elevation myocardial infarction antiplatelet therapy| Antiplatelet Therapy]] | [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy | Anticoagulant Therapy]] | [[Unstable angina / non ST elevation myocardial infarction additional management considerations for antiplatelet and anticoagulant therapy | Additional Management Considerations for Antiplatelet and Anticoagulant Therapy]]
'''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]]  


'''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]]
'''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]]


==Discharge Care==
'''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 / non ST elevation myocardial infarction medical regimen and use of medications | Medical Regimen]]===
===[[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention | Long-Term Medical Therapy and Secondary Prevention]]===
===[[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]]===


==Special Groups==
'''[[Unstable angina / non ST elevation myocardial infarction cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]'''
[[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 elderly | Elderly]]  |  [[Unstable angina / non ST elevation myocardial infarction drug and substance abusers | Drug and 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]]


==[[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.
 
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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

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Unstable angina non ST elevation myocardial infarction

CDC onUnstable angina non ST elevation myocardial infarction

Unstable angina non ST elevation myocardial infarction in the news

Blogs on Unstable angina non ST elevation myocardial infarction

to Hospitals Treating Unstable angina non ST elevation myocardial infarction

Risk calculators and risk factors for Unstable angina non ST elevation myocardial infarction

For patient information, click here

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