Non-ST-Elevation Acute Coronary Syndromes
Key Points
Key Points
- A key branch point is ST elevation or new left bundle-branch block on the ECG, which are considerations for immediate coronary angiography to determine if there is an indication for reperfusion therapy to open a likely completely occluded coronary artery.
- The imbalance may also be caused by other conditions, including excessive myocardial oxygen demand in the setting of a stable flow-limiting lesion; acute coronary insufficiency due to other causes (e.g., vasospastic [Prinzmetal] angina, coronary embolism, coronary arteritis); noncoronary causes of myocardial oxygen supply-demand mismatch (e.g., hypotension, severe anemia, hypertension, tachycardia, hypertrophic cardiomyopathy, severe aortic stenosis); nonischemic myocardial injury (e.g., myocarditis, cardiac contusion, cardiotoxic drugs); and multifactorial causes that are not mutually exclusive (e.g., stress [Takotsubo] cardiomyopathy, pulmonary embolism, severe HF, sepsis).
- If cardiac biomarkers are elevated and the clinical context is appropriate, the patient is considered to have NSTEMI. Otherwise, the patient is deemed to have UA.
- ST depression, transient ST elevation, and/or prominent T-wave inversions may be present but are not required for a diagnosis of NSTEMI.
- Abnormalities on the ECG and elevated troponins in isolation are insufficient to make the diagnosis of ACS but must be interpreted in the appropriate clinical context.
Diagnosis
...gnosis...
...Acute Coronary SyndromesThe top half of th...
...2. GRACE Risk Model NomogramHaving troub...
...e 1. TIMI Risk Scorea for NSTE-ACSHaving tr...
...linical Assessment and Initial EvaluationHaving...
...utpatient Facility PresentationHaving...
...4. Prognosis—Early Risk StratificationHav...
...e 5. Cardiac Biomarkers and the Univ...
Treatment
...reatment...
...andard Medical TherapiesHaving trouble viewing t...
...ble 7. Inhibitors of the Renin-Angiot...
...ial Antiplatelet/Anticoagulant Therapy in...
...ble 9. Early Invasive and Ischemia-Guided Strate...
...e 3. Algorithm for Management of Patients...
...Risk Stratification Before Discharge for Pat...
...Myocardial RevascularizationHaving trouble vie...
...12. Timing of Urgent CABG in Patients With NST...
...arge From the ED or Chest Pain UnitHaving...
...able 14. Factors Associated With Appropriate...
...ble 15. Dosing of Parenteral Anticoagulants D...
...Hospital Care, Hospital Discharge, and Posth...
...ity of Care and Outcomes for ACSâ€...
...able 18. Special Patient GroupsHaving troubl...