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...
...ACE Risk Model NomogramHaving trouble viewing...
...Risk Scorea for NSTE-ACSHaving trouble view...
...Clinical Assessment and Initial Evaluatio...
...ED or Outpatient Facility Present...
...ble 4. Prognosis—Early Risk StratificationHavin...
...ac Biomarkers and the Universal Definitio...
Treatment
...atment...
...dard Medical TherapiesHaving troubl...
...e 7. Inhibitors of the Renin-Angiotensi...
...Initial Antiplatelet/Anticoagulant Ther...
...Invasive and Ischemia-Guided StrategiesHaving...
...Algorithm for Management of Patients With...
...Risk Stratification Before Discharge for Patien...
...11. Myocardial RevascularizationHaving trouble...
...ming of Urgent CABG in Patients With NSTE-ACS in...
...charge From the ED or Chest Pain UnitHaving...
...ble 14. Factors Associated With Appropriate Sele...
...sing of Parenteral Anticoagulants Du...
...e Hospital Care, Hospital Discharge...
...ty of Care and Outcomes for ACS—Use...
...able 18. Special Patient GroupsHaving trouble v...