Unstable angina non ST elevation myocardial infarction: Difference between revisions

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Non-ST Elevation Myocardial Infarction
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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
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Cost-Effectiveness of Therapy
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Case #1
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Latest revision as of 20:57, 5 December 2022

For patient information, click here

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]; Bryan Piccirillo, B.S., M.D.

Synonyms and keywords: Angina at rest; rest angina; progressive angina; crescendo angina; accelerating angina; new-onset angina; pre-infarction angina; unstable angina pectoris; UAP; UA; new-onset angina; angina - unstable

Overview

Classification

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

Diagnosis

Treatment

Primary Prevention

Antiplatelet Agents: Antiplatelet Therapy Recommendations | Aspirin | Thienopyridines | Glycoprotein IIb/IIIa Inhibitor | Additional Management Considerations

Mechanical Reperfusion: Initial Conservative Versus Initial Invasive Strategies | PCI | CABG

Discharge Care: Medical Regimen | Post-Discharge Follow-Up | Cardiac Rehabilitation

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Contraindicated medications

Unstable angina is considered an absolute contraindication to the use of the following medications:

Case Studies

Case #1

Related Chapters

External Links

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

Template:WikiDoc Sources

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-[[Image:Plaque rupture and coronary thrombosis in the left anterior descending artery with distal embolization.gif|right|130pix]]
+__NOTOC__
+{| class="infobox" style="float:right;"
+|-
+| [[File:Siren.gif|30px|link=Unstable angina/ NSTEMI resident survival guide]]|| <br> || <br>
+| [[Unstable angina/ NSTEMI resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
+{{Unstable angina / NSTEMI}}
+'''For patient information, click [[Unstable angina / non ST elevation myocardial infarction (patient information)|here]]'''
-''''{{Infobox_Disease
+{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; Smita Kohli, M.D.; {{NMG}}; Bryan Piccirillo, B.S., M.D.
-| Name           = Unstable angina pectoris
-| Image          =
-| Caption        =
-| DiseasesDB     = 8695
-| ICD10          = {{ICD10|I|20||i|20}}
-| ICD9           = {{ICD9|413}}
-| ICDO           =
-| OMIM           =
-| MedlinePlus    =
-| eMedicineSubj  = med
-| eMedicineTopic = 133
-| MeshID         = D000787
-}}
-{{Search infobox}}
-{{CMG}}
+{{SK}} Angina at rest; rest angina; progressive angina; crescendo angina; accelerating angina; new-onset angina; pre-infarction angina; unstable angina pectoris; UAP; UA; new-onset angina; angina - unstable
-__NOTOC__
-'''Associate Editor-In-Chief:''' {{CZ}}; Smita Kohli, M.D.
-'''Associate Editor-In-Chief:''' {{NMG}}
+==[[Unstable angina / non ST elevation myocardial infarction overview | Overview]]==
-{{Editor Join}}
+==[[Unstable angina / non ST elevation myocardial infarction classification | Classification]]==
-'''''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
+==[[Unstable angina / non ST elevation myocardial infarction pathophysiology| Pathophysiology]]==
+[[Unstable angina pathophysiology|Unstable Angina]] | [[Non ST elevation myocardial infarction pathophysiology|Non-ST Elevation Myocardial Infarction]]
-==Overview==
+==[[Chest pain differential diagnosis|Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders]]==
-===[[Unstable angina / non ST elevation myocardial infarction overview | Overview]]===
+==[[Unstable angina / non ST elevation myocardial infarction epidemiology and demographics | Epidemiology and Demographics]]==
-===[[Unstable angina / non ST elevation myocardial infarction epidemiology and demographics | Epidemiology and Demographics]]===
+==[[Unstable angina / non ST elevation myocardial infarction risk stratification and prognosis|Risk Stratification]]==
-==Pathophysiology and Etiology==
+==[[Unstable angina / non ST elevation myocardial infarction natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-===[[Unstable angina pathophysiology & etiology|Pathophysiology and Etiology (UA)]]===
+==Special Groups==
+[[Unstable angina / non ST elevation myocardial infarction women | Women]]  |  [[Unstable angina / non ST elevation myocardial infarction diabetic patients | Diabetic Patients]]  |  [[Unstable angina / non ST elevation myocardial infarction post CABG patients | Post CABG Patients]]  |  [[Unstable angina / non ST elevation myocardial infarction elderly | Elderly]]  |  [[Unstable angina / non ST elevation myocardial infarction chronic kidney disease | Chronic Kidney Disease]]  |  [[Unstable angina / non ST elevation myocardial infarction drug and substance abusers | Substance Abusers]]  |  [[Unstable angina / non ST elevation myocardial infarction prinzmetal's angina | Prinzmetal's Angina]]  |  [[Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x | Cardiovascular Syndrome X]]
-===[[Non ST elevation myocardial infarction pathophysiology & etiology|Pathophysiology and Etiology (NSTEMI)]]===
+==Diagnosis==
+[[Unstable angina / non ST elevation myocardial infarction symptoms|History and Symptoms]] | [[Unstable angina / non ST elevation myocardial infarction physical examination|Physical Examination]] | [[Unstable angina / non ST elevation myocardial infarction blood studies|Blood Studies]] | [[Unstable angina / non ST elevation myocardial infarction biomarkers |Biomarkers]] | [[Unstable angina / non ST elevation myocardial infarction electrocardiogram|Electrocardiogram]] | [[Unstable angina / non ST elevation myocardial infarction chest x-ray|Chest X Ray]] | [[Unstable angina / non ST elevation myocardial infarction echocardiogram |Echocardiography]] | [[Unstable angina / non ST elevation myocardial infarction coronary angiography| Coronary Angiography]]
-==[[Unstable angina diagnosis| Diagnosis]]==
+==[[Unstable angina treatment|Treatment]]==
-===[[Unstable angina / non ST elevation myocardial infarction symptoms | Symptoms]]===
+'''[[Unstable angina / non ST elevation myocardial infarction primary prevention|Primary Prevention]]'''
-===[[Chest pain|Differential diagnosis of chest pain]]===
+'''Immediate Management:''' [[Unstable angina / non ST elevation myocardial infarction immediate management | Overview]] | [[Unstable angina / non ST elevation myocardial infarction oxygen therapy |Oxygen]] | [[Unstable angina / non ST elevation myocardial infarction nitrate therapy |Nitrates]] | [[Unstable angina / non ST elevation myocardial infarction analgesics | Analgesics]] | [[Unstable angina / non ST elevation myocardial infarction beta blockers | Beta Blockers]] | [[Unstable angina / non ST elevation myocardial infarction calcium channel blockers| Calcium Channel Blocker]] | [[Unstable angina / non ST elevation myocardial infarction inhibitors of RAS | Renin-Angiotensin-Aldosterone Inhibitors]]
-===[[Unstable angina / non ST elevation myocardial infarction physical examination | Physical Examination]]===
+'''Antithrombin Therapy:''' [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy | Overview]] | [[Unstable angina / non ST elevation myocardial infarction unfractionated heparin therapy |Unfractionated Heparin]] | [[Unstable angina / non ST elevation myocardial infarction low molecular weight heparin therapy |Low Molecular Weight Heparin]] | [[Unstable angina / non ST elevation myocardial infarction direct thrombin inhibitors therapy |Direct Thrombin Inhibitors]] | [[Unstable angina / non ST elevation myocardial infarction factor Xa inhibitors therapy |Factor Xa Inhibitors]] | [[Unstable angina / non ST elevation myocardial infarction long term anticoagulation therapy |Long Term Anticoagulation]]
-==[[Unstable angina risk stratification and prognosis| Risk Stratification and Prognosis]]==
+'''Antiplatelet Agents:''' [[Unstable angina/NSTEMI Antiplatelet therapy recommendations|Antiplatelet Therapy Recommendations]] | [[Unstable angina / non ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[Unstable angina / non ST elevation myocardial infarction thienopyridines|Thienopyridines]] | [[Unstable angina / non ST elevation myocardial infarction GPIIb/IIIa inhibitor|Glycoprotein IIb/IIIa Inhibitor]] |[[Unstable angina / non ST elevation myocardial infarction additional management considerations for antiplatelet and anticoagulant therapy | Additional Management Considerations]]
-==[[Unstable angina treatment| Treatment]]==
+'''Mechanical Reperfusion:''' [[Unstable angina / non ST elevation myocardial infarction initial conservative versus initial invasive strategies | Initial Conservative Versus Initial Invasive Strategies]] | [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI‎ | PCI]] | [[Unstable angina / non ST elevation myocardial infarction recommendations for CABG | CABG]]
-===[[Unstable angina / non ST elevation myocardial infarction immediate management | Immediate Management]]===
+'''Complications of Bleeding and Transfusion:''' [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion|Overview]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion incidence |Incidence]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion - definitions for bleeding complications |Definitions]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion - predictors and causes of bleeding |Predictors and Causes of Bleeding]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion - blood transfusions |Blood Transfusions]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion prognosis |Prognosis]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion prevention |Prevention]] | [[Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion recommendations |Recommendations]]
-===[[Unstable angina / non ST elevation myocardial infarction initial therapy | Initial Therapy]]===
+'''Discharge Care:''' [[Unstable angina / non ST elevation myocardial infarction medical regimen and use of medications | Medical Regimen]] | [[Unstable angina / non ST elevation myocardial infarction post-discharge follow-up | Post-Discharge Follow-Up]] | [[Unstable angina / non ST elevation myocardial infarction cardiac rehabilitation | Cardiac Rehabilitation]]
-[[Unstable angina / non ST elevation myocardial infarction antiplatelet therapy| Antiplatelet Therapy]]  |  [[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy | Anticoagulant Therapy]]  |  [[Unstable angina / non ST elevation myocardial infarction additional management considerations for antiplatelet and anticoagulant therapy | Additional Management Considerations for Antiplatelet and Anticoagulant Therapy]]
+'''Long-Term Medical Therapy and Secondary Prevention:''' [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention |Overview]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for antiplatelet therapy|Convalescent and Long-Term Antiplatelet Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for beta blockers|Beta Blockers]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for inhibitors of the RAS|Inhibition Of The Renin-Angiotensin-Aldosterone System]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for nitroglycerin|Nitroglycerin Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for calcium channel blockers|Calcium Channel Blockers]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for warfarin therapy|Warfarin Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management|Lipid Management]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for blood pressure control|Blood Pressure Control]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for smoking cessation|Smoking Cessation]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for weight management|Weight Management]] | [[UA/NSTEMI long-term medical therapy and secondary prevention ACC/AHA guidelines for Physical Activity|Physical Activity]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for patient education|Patient Education]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for influenza|Influenza]] | [[UA/NSTEMI long-term medical therapy and secondary prevention ACC/AHA guidelines depression|Depression]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines nonsteroidal anti-inflammatory drugs|Nonsteroidal Anti-Inflammatory Drugs]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines hormone therapy|Hormone Therapy]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines antioxidant vitamins and folic acid|Antioxidant Vitamins and Folic Acid]] | [[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines quality care and outcomes|Quality Care and Outcomes]]
-'''Mechanical Reperfusion'''  |  [[Unstable angina / non ST elevation myocardial infarction initial conservative versus initial invasive strategies | Initial Conservative Versus Initial Invasive Strategies]]  |  [[Unstable angina / non ST elevation myocardial infarction recommendations for PCI‎ | PCI]]  |  [[Unstable angina / non ST elevation myocardial infarction recommendations for CABG | CABG]]
+'''[[Unstable angina / non ST elevation myocardial infarction cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]'''
-In patients without ST-segment elevation on the [[electrocardiogram]], urgent [[angioplasty]] may occur anytime within the first 24 hours according to the ABOARD [[randomized controlled trial]].<ref name="pmid19724041">{{cite journal|   author=Montalescot G, Cayla G, Collet JP, Elhadad S, Beygui F, Le   Breton H et al.| title=Immediate vs delayed intervention for acute   coronary syndromes: a randomized clinical trial. | journal=JAMA | year=   2009 | volume= 302 | issue= 9 | pages= 947-54 | pmid=19724041 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19724041    | doi=10.1001/jama.2009.1267 }}</ref>
-==Discharge Care==
+'''[[Unstable angina / non ST elevation myocardial infarction future or investigational therapies|Future or Investigational Therapies]]'''
-===[[Unstable angina / non ST elevation myocardial infarction medical regimen and use of medications | Medical Regimen]]===
-===[[Unstable angina / non ST elevation myocardial infarction long-term medical therapy and secondary prevention | Long-Term Medical Therapy and Secondary Prevention]]===
-===[[Unstable angina / non ST elevation myocardial infarction post-discharge follow-up | Post-Discharge Follow-Up]]===
-===[[Unstable angina / non ST elevation myocardial infarction cardiac rehabilitation | Cardiac Rehabilitation]]===
-==Special Groups==
+====Contraindicated medications====
-[[Unstable angina / non ST elevation myocardial infarction women | Women]]  |  [[Unstable angina / non ST elevation myocardial infarction diabetic patients | Diabetic Patients]]  |  [[Unstable angina / non ST elevation myocardial infarction post CABG patients | Post CABG Patients]]  |  [[Unstable angina / non ST elevation myocardial infarction elderly | Elderly]]  |  [[Unstable angina / non ST elevation myocardial infarction chronic kidney disease | Chronic Kidney Disease]]  |  [[Unstable angina / non ST elevation myocardial infarction drug and substance abusers | Drug and Substance Abusers]]  |  [[Unstable angina / non ST elevation myocardial infarction prinzmetal's angina | Prinzmetal's Angina]]  |  [[Unstable angina / non ST elevation myocardial infarction cardiovascular syndrome x | Cardiovascular Syndrome X]]
+{{MedCondContrAbs|MedCond = Unstable angina|Dalteparin|Fingolimod|Levothyroxine}}
-==[[Unstable angina and complications of bleeding and transfusion|Complications of Bleeding and Transfusion]]==
+==Case Studies==
+[[Unstable angina / non ST elevation myocardial infarction case study one|Case #1]]
-==See Also==
+==Related Chapters==
-* [[The Living Guidelines: UA/NSTEMI | The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
+* [[Acute Coronary Syndrome risk stratification|Acute Coronary Syndrome Risk Stratification]]
 * [[Chronic stable angina]]
 * [[Non ST Elevation Myocardial Infarction]]
 * [[ST Elevation Myocardial Infarction]]
+* [[Coronary Heart Disease]]
+* [[PCI]]
-==Sources==
+==External Links==
-*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}}
-==External links==
-* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
 * [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
 * [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub 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]]
-* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack] - overview of resources from [[MedlinePlus]].
+{{WikiDoc Help Menu}}
-* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals] from the Heart and Stroke Foundation of Canada
+{{WikiDoc Sources}}
-* [http://www.regionalpci-stemi.org/index.html Regional PCI for STEMI Resource Center] - Evidence based online resource center for the development of regional PCI networks for acute STEMI
-* [http://www.stemisystems.org/ STEMI Systems] - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.
-* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
-*[http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site] - Information and resources for preventing, recognizing and treating heart attack.
-{{Circulatory system pathology}}
-{{Electrocardiography}}
-{{SIB}}
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 [[Category:Cardiology]]
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