Unstable angina / non ST elevation myocardial infarction prehospital care before onset

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Overview

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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"

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Treatment

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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 prehospital care before onset On the Web

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Risk calculators and risk factors for Unstable angina / non ST elevation myocardial infarction prehospital care before onset

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

  • Major risk factors for development of coronary heart disease have been established from several long term epidemiological studies[1] [2].
  • Various clinical trials have demonstrated that development of coronary diseases can be prevented or the risk of experiencing UA/NSTEMI in patients who have coronary heart disease can be lowered by modifying these risk factors[3][4][5].
  • The risk factors include:
  1. Smoking
  2. Overweight or obese
  3. Abnormal lipid profile
  4. Diabetes Mellitus
  5. Elevated blood pressure
  6. Physical inactivity
  7. Advanced age
  • 10 year risk of developing coronary heart disease can be assessed using calculator based on Framingham Heart Study[6] here.

References

  1. "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report". Circulation. 106 (25): 3143–421. 2002. PMID 12485966. Retrieved 2011-04-11. Unknown parameter |month= ignored (help)
  2. Lloyd-Jones DM, Leip EP, Larson MG, D'Agostino RB, Beiser A, Wilson PW, Wolf PA, Levy D (2006). "Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age". Circulation. 113 (6): 791–8. doi:10.1161/CIRCULATIONAHA.105.548206. PMID 16461820. Retrieved 2011-04-11. Unknown parameter |month= ignored (help)
  3. Ross SD, Allen IE, Connelly JE, Korenblat BM, Smith ME, Bishop D, Luo D (1999). "Clinical outcomes in statin treatment trials: a meta-analysis". Archives of Internal Medicine. 159 (15): 1793–802. PMID 10448784. Retrieved 2011-04-12.
  4. Wilson K, Gibson N, Willan A, Cook D (2000). "Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies". Archives of Internal Medicine. 160 (7): 939–44. PMID 10761958. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)
  5. Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA (2001). "AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology". Circulation. 104 (13): 1577–9. PMID 11571256. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)
  6. "Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)". JAMA : the Journal of the American Medical Association. 285 (19): 2486–97. 2001. PMID 11368702. Retrieved 2011-04-12. Unknown parameter |month= ignored (help)

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