Unstable angina / non ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system: Difference between revisions

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(New page: {{SI}} {{WikiDoc Cardiology Network Infobox}} {{CMG}} {{Editor Join}} ==Overview of Inhibition of the Renin-Angiotensin-Aldosterone System in UA / NSTEMI== ==ACC / AHA Guidelines (DO NO...)
 
 
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#redirect:[[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention]]
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==Overview of Inhibition of the Renin-Angiotensin-Aldosterone System in UA / NSTEMI==
 
==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>==
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===Class I===
 
1. [[Angiotensin-converting enzyme inhibitor]]s should be given and continued indefinitely for patients recovering from [[UA]] / [[NSTEMI]] with [[HF]], LV dysfunction ([[LVEF]] <40%), [[hypertension]], or [[diabetes mellitus]], unless contraindicated. (Level of Evidence: A)
 
2. An [[angiotensin receptor blocker]] should be prescribed at discharge to those [[UA]] / [[NSTEMI]] patients who are intolerant of an [[ACE inhibitor]] and who have either clinical or radiological signs of [[HF]] and [[LVEF]] <40%. (Level of Evidence: A)
 
3. Long term Aldosterone Receptor Blockade should be prescribed for [[UA]] / [[NSTEMI]] patients without significant renal dysfunction (estimated [[creatinine clearance]] should be >30 mL/min) or [[hyperkalemia]] ([[potassium]] should be ≤5 mEq/liter) who are already receiving therapeutic doses of an [[ACE inhibitor]], have an [[LVEF]] ≤40%, and have either symptomatic [[heart failure]] or [[diabetes mellitus]]. (Level of Evidence: A)
 
===Class IIa===
 
1. [[Angiotensin-converting enzyme inhibitor]]s are reasonable for patients recovering from [[UA]] / [[NSTEMI]] in the absence of LV dysfunction, [[hypertension]], or [[diabetes mellitus]] unless contraindicated. (Level of Evidence: A)
 
2. [[Angiotensin-converting enzyme inhibitor]]s are reasonable for patients with [[HF]] and [[LVEF]] >40%. (Level of Evidence: A)
 
3. In [[UA]] / [[NSTEMI]] patients who do not tolerate [[ACE inhibitor]]s, an [[angiotensin receptor blocker]] can be useful as an alternative to [[ACE inhibitor]]s in long term management provided there are either clinical or radiological signs of [[HF]] and [[LVEF]] <40%. (Level of Evidence: B)
 
===Class IIb===
 
1. The combination of an [[ACE inhibitor]] and an [[angiotensin receptor blocker]] may be considered in the long-term management of patients recovering from [[UA]] / [[NSTEMI]] with persistent symptomatic [[HF]] and [[LVEF]] <40% despite conventional therapy including an [[ACE inhibitor]] or an [[angiotensin receptor blocker]] alone. (Level of Evidence: B)}}
 
==Sources==
*The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |title=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=JACC |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi:10.1016/j.jacc.2007.02.013 |url=}}</ref>
 
==References==
{{reflist|2}}
 
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