Unstable angina / non ST elevation myocardial infarction drug and substance abusers: Difference between revisions
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===Class I=== | ===Class I=== | ||
1. Administration of sublingual or intravenous [[NTG]] and intravenous or oral [[calcium antagonist]]s is recommended for patients with [[ST segment elevation]] or depression that accompanies [[ischemic chest discomfort]] after [[cocaine use]]. (Level of Evidence: C) | 1. Administration of sublingual or intravenous [[NTG]] and intravenous or oral [[calcium antagonist]]s is recommended for patients with [[ST segment elevation]] or depression that accompanies [[ischemic chest discomfort]] after [[cocaine use]]. ''(Level of Evidence: C)'' | ||
2. Immediate [[coronary angiography]], if possible, should be performed in patients with [[ischemic chest discomfort]] after [[cocaine use]] whose [[ST segment]]s remain elevated after [[NTG]] and [[calcium antagonist]]s; [[PCI]] is recommended if occlusive [[thrombus]] is detected. (Level of Evidence: C) | 2. Immediate [[coronary angiography]], if possible, should be performed in patients with [[ischemic chest discomfort]] after [[cocaine use]] whose [[ST segment]]s remain elevated after [[NTG]] and [[calcium antagonist]]s; [[PCI]] is recommended if occlusive [[thrombus]] is detected. ''(Level of Evidence: C)'' | ||
3. Fibrinolytic therapy is useful in patients with [[ischemic chest discomfort]] after [[cocaine use]] if [[ST segment]]s remain elevated despite [[NTG]] and [[calcium antagonist]]s, if there are no contraindications, and if [[coronary angiography]] is not possible. (Level of Evidence: C) | 3. Fibrinolytic therapy is useful in patients with [[ischemic chest discomfort]] after [[cocaine use]] if [[ST segment]]s remain elevated despite [[NTG]] and [[calcium antagonist]]s, if there are no contraindications, and if [[coronary angiography]] is not possible. ''(Level of Evidence: C)'' | ||
===Class IIa=== | ===Class IIa=== | ||
1. Administration of [[NTG]] or oral [[calcium channel blocker]]s can be beneficial for patients with normal [[ECG]]s or minimal [[ST segment deviation]] suggestive of [[ischemia]] after [[cocaine use]]. (Level of Evidence: C) | 1. Administration of [[NTG]] or oral [[calcium channel blocker]]s can be beneficial for patients with normal [[ECG]]s or minimal [[ST segment deviation]] suggestive of [[ischemia]] after [[cocaine use]]. ''(Level of Evidence: C)'' | ||
2. [[Coronary angiography]], if available, is probably recommended for patients with [[ischemic chest discomfort]] after [[cocaine use]] with [[ST-segment depression]] or isolated [[T wave]] changes not known to be previously present and who are unresponsive to [[NTG]] and [[calcium antagonist]]s. (Level of Evidence: C) | 2. [[Coronary angiography]], if available, is probably recommended for patients with [[ischemic chest discomfort]] after [[cocaine use]] with [[ST-segment depression]] or isolated [[T wave]] changes not known to be previously present and who are unresponsive to [[NTG]] and [[calcium antagonist]]s. ''(Level of Evidence: C)'' | ||
3. Management of [[UA]] / [[NSTEMI]] patients with [[methamphetamine]] use similar to that of patients with [[cocaine use]] is reasonable. (Level of Evidence: C) | 3. Management of [[UA]] / [[NSTEMI]] patients with [[methamphetamine]] use similar to that of patients with [[cocaine use]] is reasonable. ''(Level of Evidence: C)'' | ||
===Class IIb=== | ===Class IIb=== | ||
1. Administration of combined alpha and beta blocking agents (e.g., [[labetalol]]) may be reasonable for patients after [[cocaine use]] with [[hypertension]] (systolic blood pressure >150 mm Hg) or those with [[sinus tachycardia]] (pulse >100 bpm) provided that the patient has received a vasodilator, such as [[NTG]] or a [[calcium antagonist]], within close temporal proximity (i.e., within the previous hour). (Level of Evidence: C) | 1. Administration of combined alpha and beta blocking agents (e.g., [[labetalol]]) may be reasonable for patients after [[cocaine use]] with [[hypertension]] (systolic blood pressure >150 mm Hg) or those with [[sinus tachycardia]] (pulse >100 bpm) provided that the patient has received a vasodilator, such as [[NTG]] or a [[calcium antagonist]], within close temporal proximity (i.e., within the previous hour). ''(Level of Evidence: C)'' | ||
===Class III=== | ===Class III=== | ||
1. [[Coronary angiography]] is not recommended in patients with [[chest pain]] after [[cocaine use]] without [[ST segment]] or [[T wave]] changes and with a negative [[stress test]] and [[cardiac biomarker]]s. (Level of Evidence: C)}} | 1. [[Coronary angiography]] is not recommended in patients with [[chest pain]] after [[cocaine use]] without [[ST segment]] or [[T wave]] changes and with a negative [[stress test]] and [[cardiac biomarker]]s. ''(Level of Evidence: C)''}} | ||
==See Also== | |||
* [[The Living Guidelines: UA/NSTEMI | The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | |||
==Sources== | ==Sources== |
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Overview of Drug and Substance Abusers with UA / NSTEMI
ACC / AHA Guidelines (DO NOT EDIT) [1]
“ |
Class I1. Administration of sublingual or intravenous NTG and intravenous or oral calcium antagonists is recommended for patients with ST segment elevation or depression that accompanies ischemic chest discomfort after cocaine use. (Level of Evidence: C) 2. Immediate coronary angiography, if possible, should be performed in patients with ischemic chest discomfort after cocaine use whose ST segments remain elevated after NTG and calcium antagonists; PCI is recommended if occlusive thrombus is detected. (Level of Evidence: C) 3. Fibrinolytic therapy is useful in patients with ischemic chest discomfort after cocaine use if ST segments remain elevated despite NTG and calcium antagonists, if there are no contraindications, and if coronary angiography is not possible. (Level of Evidence: C) Class IIa1. Administration of NTG or oral calcium channel blockers can be beneficial for patients with normal ECGs or minimal ST segment deviation suggestive of ischemia after cocaine use. (Level of Evidence: C) 2. Coronary angiography, if available, is probably recommended for patients with ischemic chest discomfort after cocaine use with ST-segment depression or isolated T wave changes not known to be previously present and who are unresponsive to NTG and calcium antagonists. (Level of Evidence: C) 3. Management of UA / NSTEMI patients with methamphetamine use similar to that of patients with cocaine use is reasonable. (Level of Evidence: C) Class IIb1. Administration of combined alpha and beta blocking agents (e.g., labetalol) may be reasonable for patients after cocaine use with hypertension (systolic blood pressure >150 mm Hg) or those with sinus tachycardia (pulse >100 bpm) provided that the patient has received a vasodilator, such as NTG or a calcium antagonist, within close temporal proximity (i.e., within the previous hour). (Level of Evidence: C) Class III1. Coronary angiography is not recommended in patients with chest pain after cocaine use without ST segment or T wave changes and with a negative stress test and cardiac biomarkers. (Level of Evidence: C) |
” |
See Also
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 1.0 1.1 Anderson JL, Adams CD, Antman EM; et al. (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". JACC. 50 (7): e1–e157. PMID 17692738. Text "doi:10.1016/j.jacc.2007.02.013 " ignored (help); Unknown parameter
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