Unstable angina non ST elevation myocardial infarction natural history, complications and prognosis: Difference between revisions
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===Prognosis of Unstable Angina Pectoris=== | ===Prognosis of Unstable Angina Pectoris=== | ||
In unstable angina adverse events tend to occur early after admission and can be predicted by clinical and EKG characteristics. The greater the magnitude and duration of EKG changes, the poorer the prognosis. ST depression on EKG at admission and the presence of transient ischemia predicted an increased risk of MI and subsequent death whereas normal EKG patterns are associated with a good outcome. 1 year MI or death rate in patients with new ST deviation (more than 1 mm from baseline) has been shown to be 11% compared to 6.8% in patients with isolated [[T-wave inversion]]. The most powerful predictors of [[MI]] and [[death]] include history of [[hypertension]] and presence of transient ischemia. Similarly persistence of pain is also associated with an unfavorable outcome. | In unstable angina adverse events tend to occur early after admission and can be predicted by clinical and EKG characteristics. The greater the magnitude and duration of EKG changes, the poorer the prognosis. ST depression on EKG at admission and the presence of transient ischemia predicted an increased risk of MI and subsequent death whereas normal EKG patterns are associated with a good outcome. 1 year MI or death rate in patients with new ST deviation (more than 1 mm from baseline) has been shown to be 11% compared to 6.8% in patients with isolated [[T-wave inversion]]. The most powerful predictors of [[MI]] and [[death]] include history of [[hypertension]] and presence of transient ischemia. Similarly persistence of pain is also associated with an unfavorable outcome. | ||
Significant determinants of poor outcome include: | |||
* Congestive heart failure | |||
* Hypotension | |||
* New or worsening mitral regurgitation | |||
* Sustained Ventricular tachycardia | |||
* Poor ejection fraction | |||
* Refractory angina | |||
===Prognosis in NSTEMI === | ===Prognosis in NSTEMI === | ||
Revision as of 21:55, 2 December 2012
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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Unstable angina non ST elevation myocardial infarction natural history, complications and prognosis On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Unstable angina / NSTEMI are signs of more severe heart disease. Natural history is complicated by the development of arrhythmias and heart failure. In a study it was shown that 14% of the cases of unstable angina can progress to MI. Sudden death is an infrequent sequel of both UA and NSTEMI.
Complications
Unstable angina
The incidence of ischemic complications and the risk of death in unstable angina pectoris is lower than that of patients with either non ST elevation myocardial infarction (NSTEMI) or that or patients with ST segment elevation myocardial infarction (STEMI) but higher than that of patients with chronic stable angina pectoris. Unstable angina can lead to:
- Cardiac arrhythmias
- Congestive heart failure
- Hypotension
- New mitral regurgitation
- MI - one of the most common complication. Incidence is greatest within the first 6-8 weeks after admission.
- Sudden death - infrequent complication and results from arrhythmias and MI
List of factors that may effect the development and complications of NSTEMI
(In alphabetical order)
- Blood lipid levels
- Catecholamine levels (smoking, cocaine, stress)
- Degree of coronary vasoconstriction
- Endothelial function
- Extent of collaterals
- Extent of plaque rupture or erosion
- Inflammatory substrate
- Location of the culprit coronary lesion
- Microembolization and microvascular obstruction
- Stenosis morphology and severity
- Systemic factors
- Heart rate and blood pressure
- Thrombotic factors
- Blood viscosity
- Intrinsic clotting activity
- Leukocyte activation
- Level of fibrinolytic activity
- Plaque tissue factor levels
- Platelet aggregability and reactivity
Prognosis
Prognosis of Unstable Angina Pectoris
In unstable angina adverse events tend to occur early after admission and can be predicted by clinical and EKG characteristics. The greater the magnitude and duration of EKG changes, the poorer the prognosis. ST depression on EKG at admission and the presence of transient ischemia predicted an increased risk of MI and subsequent death whereas normal EKG patterns are associated with a good outcome. 1 year MI or death rate in patients with new ST deviation (more than 1 mm from baseline) has been shown to be 11% compared to 6.8% in patients with isolated T-wave inversion. The most powerful predictors of MI and death include history of hypertension and presence of transient ischemia. Similarly persistence of pain is also associated with an unfavorable outcome. Significant determinants of poor outcome include:
- Congestive heart failure
- Hypotension
- New or worsening mitral regurgitation
- Sustained Ventricular tachycardia
- Poor ejection fraction
- Refractory angina
Prognosis in NSTEMI
Cardiac Troponin I is a very sensitive marker of degree of myocardial damage and provides a prognostic value in patients with NSTEMI.
Related Chapters
- The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines
- Chronic stable angina
- ST Elevation Myocardial Infarction
Sources
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [1]
References
- ↑ 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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- Pages with citations using unnamed parameters
- Pages with citations using unsupported parameters
- CS1 maint: Explicit use of et al.
- CS1 maint: Multiple names: authors list
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