Unstable angina non ST elevation myocardial infarction nitrate therapy: Difference between revisions
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{{CMG}} | {{CMG}} | ||
__NOTOC__ | __NOTOC__ | ||
'''Associate Editor-In-Chief:''' {{CZ}}; Smita Kohli, M.D. | '''Associate Editor-In-Chief:''' {{CZ}}; Smita Kohli, M.D.; {{NMG}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | ||
{{Editor Join}} | {{Editor Join}} | ||
==Mechanism of Benefit== | ==Mechanism of Benefit== | ||
*[[Nitroglycerin]], an endothelium-independent [[vasodilator]], has both peripheral and coronary vascular effects. | *[[Nitroglycerin]] (NTG), an endothelium-independent [[vasodilator]], has both peripheral and coronary vascular effects. | ||
*By venodilation, it decreases the myocardial [[preload]], ultimately, decreasing the myocardial oxygen demand. | *By venodilation, it decreases the myocardial [[preload]], ultimately, decreasing the myocardial oxygen demand. | ||
*It also dilates the coronary arteries, thus, decreasing the amount of stenosis and relieves pain. | *It also dilates the coronary arteries, thus, decreasing the amount of [[stenosis]] and relieves pain. | ||
*In addition, it promotes collateral flow and redistribution of [[coronary blood flow]] to ischemic regions. | *In addition, it promotes collateral flow and redistribution of [[coronary blood flow]] to ischemic regions. | ||
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*It will also be helpful in patients with [[heart failure]] and [[hypertension]]. | *It will also be helpful in patients with [[heart failure]] and [[hypertension]]. | ||
==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid21444888">{{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 |title=2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=March |pmid=21444888 |doi=10.1161/CIR.0b013e318212bb8b |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21444888 |accessdate=2011-04-08}}</ref><ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, | ==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid21444888">{{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 |title=2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=March |pmid=21444888 |doi=10.1161/CIR.0b013e318212bb8b |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21444888 |accessdate=2011-04-08}}</ref><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>== | ||
{{cquote| | {{cquote| | ||
===Class I=== | ===Class I=== | ||
1. Patients with [[ | 1. Patients with [[Unstable angina]] / [[NSTEMI]] with ongoing ischemic discomfort should receive sublingual [[NTG]] (0.4 mg) every 5 min for a total of 3 doses, after which assessment should be made about the need for intravenous [[NTG]], if not contraindicated. (Level of Evidence: C) | ||
2. Intravenous [[NTG]] is indicated in the first 48 h after [[ | 2. Intravenous [[NTG]] is indicated in the first 48 h after [[Unstable angina]] / [[NSTEMI]] for treatment of persistent [[ischemia]], [[heart failure]], or [[hypertension]]. The decision to administer intravenous [[NTG]] and the dose used should not preclude therapy with other proven mortality reducing interventions such as [[beta blockers]] or [[ACE inhibitors]]. (Level of Evidence: B) | ||
===Class III=== | ===Class III=== | ||
1. [[Nitrates]] should not be administered to [[ | 1. [[Nitrates]] should not be administered to [[Unstable angina]] / [[NSTEMI]] patients with systolic blood pressure <90mmHg or ≥30 mmHg below baseline, severe [[bradycardia]] (<50 bpm), [[tachycardia]] (>100 bpm) in the absence of symptomatic [[heart failure]], or [[right ventricular infarction]]. (Level of Evidence: C) | ||
2. [[Nitroglycerin]] or other [[nitrates]] should not be administered to patients with [[ | 2. [[Nitroglycerin]] or other [[nitrates]] should not be administered to patients with [[Unstable Angina]] / [[NSTEMI]] who had received a phosphodiesterase inhibitor for [[erectile dysfunction]] within 24 h of [[sildenafil]] or 48 h of [[tadalafil]] use. The suitable time for the administration of [[nitrates]] after [[vardenafil]] has not been determined. (Level of Evidence: C)}} | ||
==Sources== | ==Sources== | ||
*2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid21444888">{{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 |title=2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=March |pmid=21444888 |doi=10.1161/CIR.0b013e318212bb8b |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21444888 |accessdate=2011-04-08}}</ref> | *2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines<ref name="pmid21444888">{{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 |title=2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=March |pmid=21444888 |doi=10.1161/CIR.0b013e318212bb8b |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21444888 |accessdate=2011-04-08}}</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, | * 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=2011-04-11}}</ref> | ||
==References== | ==References== | ||
Revision as of 14:42, 11 April 2011
| Unstable angina pectoris | |
| ICD-10 | I20 |
|---|---|
| ICD-9 | 413 |
| DiseasesDB | 8695 |
| eMedicine | med/133 |
| MeSH | D000787 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Neil Gheewala, M.D. [3]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [4] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Mechanism of Benefit
- Nitroglycerin (NTG), an endothelium-independent vasodilator, has both peripheral and coronary vascular effects.
- By venodilation, it decreases the myocardial preload, ultimately, decreasing the myocardial oxygen demand.
- It also dilates the coronary arteries, thus, decreasing the amount of stenosis and relieves pain.
- In addition, it promotes collateral flow and redistribution of coronary blood flow to ischemic regions.
Dosing
- If three sublingual 0.4mg tablets of NTG fail to relieve the pain, intravenous NTG may be initiated along with oral or intravenous beta blocker.
Indications
- It will also be helpful in patients with heart failure and hypertension.
ACC / AHA Guidelines (DO NOT EDIT) [1][2]
| “ |
Class I1. Patients with Unstable angina / NSTEMI with ongoing ischemic discomfort should receive sublingual NTG (0.4 mg) every 5 min for a total of 3 doses, after which assessment should be made about the need for intravenous NTG, if not contraindicated. (Level of Evidence: C) 2. Intravenous NTG is indicated in the first 48 h after Unstable angina / NSTEMI for treatment of persistent ischemia, heart failure, or hypertension. The decision to administer intravenous NTG and the dose used should not preclude therapy with other proven mortality reducing interventions such as beta blockers or ACE inhibitors. (Level of Evidence: B) Class III1. Nitrates should not be administered to Unstable angina / NSTEMI patients with systolic blood pressure <90mmHg or ≥30 mmHg below baseline, severe bradycardia (<50 bpm), tachycardia (>100 bpm) in the absence of symptomatic heart failure, or right ventricular infarction. (Level of Evidence: C) 2. Nitroglycerin or other nitrates should not be administered to patients with Unstable Angina / NSTEMI who had received a phosphodiesterase inhibitor for erectile dysfunction within 24 h of sildenafil or 48 h of tadalafil use. The suitable time for the administration of nitrates after vardenafil has not been determined. (Level of Evidence: C) |
” |
Sources
- 2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines[1]
- The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction [2]
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 (2011). "2011 ACCF/AHA Focused Update Incorporated Into the 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 Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888. Retrieved 2011-04-08. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 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
|month=ignored (help)