Unstable angina non ST elevation myocardial infarction: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 1: Line 1:
'''For patient information click [[Unstable angina (patient information)|here]]'''
'''For patient information click [[Unstable angina / non ST elevation myocardial infarction (patient information)|here]]'''


__NOTOC__
'''{{Infobox_Disease  
'''{{Infobox_Disease  
| Name          = Unstable angina pectoris  
| Name          = Unstable angina pectoris  

Revision as of 17:23, 28 July 2011

For patient information click here

Unstable angina pectoris
ICD-10 I20
ICD-9 413
DiseasesDB 8695
MeSH D000787

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

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]

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

Overview

Acute coronary syndromes (ACS) is a term that encompasses unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).

While all three usually result from atherosclerotic plaque rupture and subsequent thrombus formation in one of the main epicardial coronary arteries, with subsequent inadequate blood supply to meet the oxygen and metabolic demands of the myocardium. Other possible etiologies of this imbalance such as coronary artery narrowing alone, coronary spasm, or coronary dissection.

Unstable angina, NSTEMI and STEMI are distinguished pathophysiologically as to whether or not the thrombus is occlusive (as in the case of STEMI) or non-occlusive(as in the case of UA and NSTEMI). If an electrocardiogram (EKG) is performed at the time that an occlusive coronary artery thrombus is formed, it will usually show ST-segment elevation in the leads which correspond to the territory of myocardium in which blood supply has been disrupted (see Electrocardiogram). If an EKG is performed at the time that a non-occlusive thrombus is formed, it may or may not show signs of ischemia(see Electrocardiogram).

Frequently, Unstable Angina and NSTEMI are indistinguishable on inital evaluation as these two conditions are at different spectrums of ischemia. If the ischemia is significant to cause myocardial damage, there will be an elevation of Cardiac biomarkers (CK-MB or troponin) and would be classified as an NSTEMI(see Biomarkers). Often, these may not be detected for up to 12 hours in the bloodstream, which emphasizes the need for thorough evaluation. [1] [2]

Pathophysiology and Etiology

Unstable Angina | Non-ST Elevation Myocardial Infarction

Epidemiology and Demographics

Risk Factors

Risk Stratification | Guidelines for Early Risk Stratification | Guidelines for Risk Stratification before discharge

Natural history, Complications and Prognosis

Diagnosis

Differential diagnosis | Initial Therapy | History & Symptoms | Physical Examination | Biomarkers | Electrocardiogram | Chest X-Ray | Echocardiography | Coronary Angiography

Treatment

Pre-hospital Care : Before Onset | After Onset

Immediate Management : Overview | Oxygen | Nitrates | Analgesics | Beta Blockers | Calcium Channel Blocker | Inhibitors of Renin-Angiotensin-Aldosterone axis | ACC/AHA Guidelines for immediate management

Antithrombin Therapy : Overview | Unfractionated Heparin | Low Molecular Weight Heparin | Direct Thrombin Inhibitors | Factor Xa Inhibitors | Long Term Anticoagulation | ACC/AHA Guidelines for Anticoagulation

Antitplatelet Agents : Aspirin | Thienopyridines | Glycoprotein IIb/IIIa Inhibitor

Additional Management Considerations for Antiplatelet and Anticoagulant Therapy

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 | Antiplatelet Therapy | Beta Blockers | Inhibition Of The Renin-Angiotensin-Aldosterone System | Nitroglycerin Therapy | Calcium Channel Blockers | Warfarin Therapy | Lipid Management | Blood Pressure Control | Diabetes Mellitus | Smoking Cessation | Weight Management | Physical Activity | Patient Education | Influenza Vaccination | Depression | Nonsteroidal Anti-Inflammatory Drugs | Hormone Therapy | Antioxidant Vitamins and Folic Acid

Special Groups

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

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: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[3]
  • The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [4]

References

  1. 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
  2. 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
  3. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS (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. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888. Retrieved 2011-04-08. Unknown parameter |month= ignored (help)
  4. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B (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". Journal of the American College of Cardiology. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Retrieved 2011-04-11. Unknown parameter |month= ignored (help)

External links


Template:WikiDoc Sources