Acute coronary syndromes: Difference between revisions
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==[[Acute coronary syndrome initial management|Guidelines for management of AF Complicating ACS]]== | ==[[Acute coronary syndrome initial management|Guidelines for management of AF Complicating ACS]]== | ||
==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>== | |||
====AF Complicating Acute Coronary Syndrome==== | |||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Urgent direct-current [[cardioversion]] of new-onset [[AF]] in the setting of [[ACS]] is recommended for patients with [[hemodynamic]] compromise, ongoing [[ischemia]], or inadequate rate control. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Intravenous]] [[beta blockers]] are recommended to slow a rapid ventricular response to [[AF]] in patients with [[ACS]] who do not display [[HF]], [[hemodynamic]] instability, or [[bronchospasm]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' For patients with [[ACS]] and [[AF]] with [[CHA2DS2-VASc score]] of 2 or greater, [[anticoagulation]] with [[warfarin]] is recommended unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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{|class="wikitable" style="width: 80%;" | |||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of [[amiodarone]] or [[digoxin]] may be considered to slow a rapid ventricular response in patients with [[ACS]] and [[AF]] associated with severe LV dysfunction and [[HF]] or [[hemodynamic]] instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Administration of [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonists]] might be considered to slow a rapid ventricular response in patients with [[ACS]] and [[AF]] only in the absence of significant [[HF]] or [[hemodynamic]] instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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====AF Complicating Acute Coronary Syndrome==== | ====AF Complicating Acute Coronary Syndrome==== | ||
Revision as of 17:01, 26 October 2016
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Resident Survival Guide |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: ACS
Overview
Acute coronary syndrome (ACS) refers to any group of symptoms attributed to obstruction of the coronary arteries. The most common symptom prompting diagnosis of ACS is chest pain, often radiating of the left arm or angle of the jaw, pressure-like in character, and associated with nausea and sweating. Acute coronary syndrome usually occurs as a result of one of three problems: ST-elevation myocardial infarction (30%), non ST-elevation myocardial infarction (25%), or unstable angina (38%).[1] These types are named according to the appearance of the electrocardiogram.[2] There can be some variation as to which forms of myocardial infarction (MI) are classified under acute coronary syndrome.
ACS should be distinguished from stable angina, which is chest pain which develops during exertion and resolves at rest. New onset angina however should be considered as a part of acute coronary syndrome, since it suggests a new problem in a coronary artery.Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use.[3] Cardiac chest pain can also be precipitated by anemia, bradycardias (excessively slow heart rate) or tachycardias (excessively fast heart rate).
Acute Coronary Syndrome
Acute coronary syndrome may refer to either of the three conditions listed below. For detailed information on the specific type of acute coronary syndrome, click on the links.
Diagnosis Using the Clinical Prediction Rule [4][5]
Guidelines for Risk Stratification
Guidelines for Pre-hospital Evaluation and Care
Guidelines for Initial Management
Guidelines for management of AF Complicating ACS
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[6]
AF Complicating Acute Coronary Syndrome
| Class I |
| "1. Urgent direct-current cardioversion of new-onset AF in the setting of ACS is recommended for patients with hemodynamic compromise, ongoing ischemia, or inadequate rate control. (Level of Evidence: C)" |
| "2. Intravenous beta blockers are recommended to slow a rapid ventricular response to AF in patients with ACS who do not display HF, hemodynamic instability, or bronchospasm. (Level of Evidence: C)" |
| "3. For patients with ACS and AF with CHA2DS2-VASc score of 2 or greater, anticoagulation with warfarin is recommended unless contraindicated. (Level of Evidence: C)" |
| Class IIb |
| "1. Administration of amiodarone or digoxin may be considered to slow a rapid ventricular response in patients with ACS and AF associated with severe LV dysfunction and HF or hemodynamic instability. (Level of Evidence: C)" |
| "2. Administration of nondihydropyridine calcium antagonists might be considered to slow a rapid ventricular response in patients with ACS and AF only in the absence of significant HF or hemodynamic instability. (Level of Evidence: C)" |
AF Complicating Acute Coronary Syndrome
| Class I |
| "1. Urgent direct-current cardioversion of new-onset AF in the setting of ACS is recommended for patients with hemodynamic compromise, ongoing ischemia, or inadequate rate control. (Level of Evidence: C)" |
| "2. Intravenous beta blockers are recommended to slow a rapid ventricular response to AF in patients with ACS who do not display HF, hemodynamic instability, or bronchospasm. (Level of Evidence: C)" |
| "3. For patients with ACS and AF with CHA2DS2-VASc score of 2 or greater, anticoagulation with warfarin is recommended unless contraindicated. (Level of Evidence: C)" |
| Class IIb |
| "1. Administration of amiodarone or digoxin may be considered to slow a rapid ventricular response in patients with ACS and AF associated with severe LV dysfunction and HF or hemodynamic instability. (Level of Evidence: C)" |
| "2. Administration of nondihydropyridine calcium antagonists might be considered to slow a rapid ventricular response in patients with ACS and AF only in the absence of significant HF or hemodynamic instability. (Level of Evidence: C)" |
References
- ↑ Torres M, Moayedi S (2007). "Evaluation of the acutely dyspneic elderly patient". Clin. Geriatr. Med. 23 (2): 307–25, vi. doi:10.1016/j.cger.2007.01.007. PMID 17462519. Unknown parameter
|month=ignored (help) - ↑ Grech ED, Ramsdale DR (2003). "Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction". BMJ. 326 (7401): 1259–61. doi:10.1136/bmj.326.7401.1259. PMC 1126130. PMID 12791748. Unknown parameter
|month=ignored (help) - ↑ Achar SA, Kundu S, Norcross WA (2005). "Diagnosis of acute coronary syndrome". Am Fam Physician. 72 (1): 119–26. PMID 16035692.
- ↑ Christenson J, Innes G, McKnight D, Thompson CR, Wong H, Yu E; et al. (2006). "A clinical prediction rule for early discharge of patients with chest pain". Ann Emerg Med. 47 (1): 1–10. doi:10.1016/j.annemergmed.2005.08.007. PMID 16387209.
- ↑ Jalili M, Hejripour Z, Honarmand AR, Pourtabatabaei N (2012). "Validation of the vancouver chest pain rule: a prospective cohort study". Acad Emerg Med. 19 (7): 837–42. doi:10.1111/j.1553-2712.2012.01399.x. PMID 22805631.
- ↑ January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.