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{{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | {{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | ||
==ACC / AHA Guidelines - Inhibition Of The Renin-Angiotensin-Aldosterone System(DO NOT EDIT) | ==ACC / AHA 2007 Guidelines - Unstable Angina / NSTEMI - Secondary Prevention with Inhibition Of The Renin-Angiotensin-Aldosterone System(DO NOT EDIT) <ref name="pmid17692738">{{cite journal|author=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 |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=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157|year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6|accessdate=2011-04-11}}</ref>== | ||
{ | {|class="wikitable" | ||
== | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"| | |||
'''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 | <nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])''<nowiki>"</nowiki> | ||
|- | |||
| bgcolor="LightGreen"| | |||
'''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 | <nowiki>"</nowiki>'''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%. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])'' | ||
<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"| | |||
'''3.''' Long term [[Aldosterone antagonist]] 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 | <nowiki>"</nowiki>'''3.''' Long term [[Aldosterone antagonist]] 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]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])'' | ||
<nowiki>"</nowiki> | |||
|} | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]= | {|class="wikitable" | ||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
'''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 | <nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])'' | ||
<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
'''2.''' [[Angiotensin-converting enzyme inhibitor]]s are reasonable for patients with [[HF]]and [[LVEF]] >40%. ''(Level of Evidence | <nowiki>"</nowiki>'''2.''' [[Angiotensin-converting enzyme inhibitor]]s are reasonable for patients with [[HF]]and [[LVEF]] >40%. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])'' | ||
<nowiki>"</nowiki> | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
'''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 | <nowiki>"</nowiki>'''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%. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])'' | ||
<nowiki>"</nowiki> | |||
|} | |||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]= | {|class="wikitable" | ||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon"| | |||
'''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 | <nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])'' | ||
<nowiki>"</nowiki> | |||
|} | |||
==See Also== | ==See Also== | ||
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==Sources== | ==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, 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 |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=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157|year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6|accessdate=2011-04-12}}</ref> | *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, 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 |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=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157|year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6|accessdate=2011-04-12}}</ref> | ||
==References== | ==References== |
Revision as of 18:25, 10 October 2012
Unstable angina / NSTEMI Microchapters |
Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
Special Groups |
Diagnosis |
Laboratory Findings |
Treatment |
Antitplatelet 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 |
Discharge Care |
Case Studies |
Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for inhibitors of the RAS On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
ACC / AHA 2007 Guidelines - Unstable Angina / NSTEMI - Secondary Prevention with Inhibition Of The Renin-Angiotensin-Aldosterone System(DO NOT EDIT) [1]
Class I |
"1. Angiotensin-converting enzyme inhibitors 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 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 A) " |
"3. Long term Aldosterone antagonist 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 A) " |
Class IIa |
"1. Angiotensin-converting enzyme inhibitors are reasonable for patients recovering from UA / NSTEMI in the absence of LV dysfunction, hypertension, or diabetes mellitus unless contraindicated. (Level A) " |
"2. Angiotensin-converting enzyme inhibitors are reasonable for patients with HFand LVEF >40%. (Level A) " |
"3. In UA / NSTEMI patients who do not tolerate ACE inhibitors, anangiotensin receptor blocker can be useful as an alternative to ACE inhibitors in long term management provided there are either clinical or radiological signs of HF andLVEF <40%. (Level 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 anACE inhibitor or an angiotensin receptor blocker alone. (Level B) " |
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, 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
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