Unstable angina non ST elevation myocardial infarction
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| Unstable angina pectoris | |
| ICD-10 | I20 |
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| ICD-9 | 413 |
| DiseasesDB | 8695 |
| MeSH | D000787 |
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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Unstable angina non ST elevation myocardial infarction On the Web |
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CDC onUnstable angina non ST elevation myocardial infarction |
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Unstable angina non ST elevation myocardial infarction in the news |
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Blogs on Unstable angina non ST elevation myocardial infarction |
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to Hospitals Treating Unstable angina non ST elevation myocardial infarction |
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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
- The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines
- Chronic stable angina
- Non ST Elevation Myocardial Infarction
- ST Elevation Myocardial Infarction
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
- ↑ 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
- ↑ 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
- ↑ 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) - ↑ 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
- The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research
- Clinical Trial Results: An up to date resource of Cardiovascular Research
- 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
- Heart Attack - overview of resources from MedlinePlus.
- Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada
- Regional PCI for STEMI Resource Center - Evidence based online resource center for the development of regional PCI networks for acute STEMI
- STEMI Systems - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
- American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.
- American Heart Association's Heart Attack web site - Information and resources for preventing, recognizing and treating heart attack.