Unstable angina / non ST elevation myocardial infarction

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Overview

Classification

Pathophysiology

Unstable Angina
Non-ST Elevation Myocardial Infarction

Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders

Epidemiology and Demographics

Risk Stratification

Natural History, Complications and Prognosis

Special Groups

Women
Heart Failure and Cardiogenic Shock
Perioperative NSTE-ACS Related to Noncardiac Surgery
Stress (Takotsubo) Cardiomyopathy
Diabetic Mellitus
Post CABG Patients
Older Adults
Chronic Kidney Disease
Angiographically Normal Coronary Arteries
Variant (Prinzmetal's) Angina
Substance abuse
Cardiovascular "Syndrome X"

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Blood Studies
Biomarkers

Electrocardiogram

Chest X Ray

Echocardiography

Coronary Angiography

Treatment

Primary Prevention

Immediate Management

Anti-Ischemic and Analgesic Therapy

Cholesterol Management

Antitplatelet Therapy

Antiplatelet therapy recommendations
Aspirin
Thienopyridines
Glycoprotein IIb/IIIa Inhibitor

Anticoagulant 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

Initial Conservative Versus Initial Invasive Strategies
PCI
CABG

Complications of Bleeding and Transfusion

Discharge Care

Medical Regimen
Post-Discharge Follow-Up
Cardiac Rehabilitation

Long-Term Medical Therapy and Secondary Prevention

ICD implantation within 40 days of myocardial infarction

ICD within 90 days of revascularization

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Unstable angina / non ST elevation myocardial infarction On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.; Smita Kohli, M.D.; Neil Gheewala, M.D. [3]; Bryan Piccirillo, B.S., M.D.

Synonyms and Keywords: Angina at rest; rest angina; progressive angina; crescendo angina; accelerating angina; new-onset angina; pre-infarction angina; unstable angina pectoris; UAP; UA; new-onset angina; angina - unstable

Overview

Classification

Pathophysiology

Unstable Angina | Non-ST Elevation Myocardial Infarction

Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders

Epidemiology and Demographics

Risk Stratification

Natural History, Complications and Prognosis

Special Groups

Women | Diabetic Patients | Post CABG Patients | Elderly | Chronic Kidney Disease | Substance Abusers | Prinzmetal's Angina | Cardiovascular Syndrome X

Diagnosis

History and Symptoms | Physical Examination | Blood Studies | Biomarkers | Electrocardiogram | Chest X Ray | Echocardiography | Coronary Angiography

Treatment

Primary Prevention

Immediate Management: Overview | Oxygen | Nitrates | Analgesics | Beta Blockers | Calcium Channel Blocker | Renin-Angiotensin-Aldosterone Inhibitors

Antithrombin Therapy: Overview | Unfractionated Heparin | Low Molecular Weight Heparin | Direct Thrombin Inhibitors | Factor Xa Inhibitors | Long Term Anticoagulation

Antiplatelet Agents: Antiplatelet Therapy Recommendations | Aspirin | Thienopyridines | Glycoprotein IIb/IIIa Inhibitor | Additional Management Considerations

Mechanical Reperfusion: Initial Conservative Versus Initial Invasive Strategies | PCI | CABG

Complications of Bleeding and Transfusion: Overview | Incidence | Definitions | Predictors and Causes of Bleeding | Blood Transfusions | Prognosis | Prevention | Recommendations

Discharge Care: Medical Regimen | Post-Discharge Follow-Up | Cardiac Rehabilitation

Long-Term Medical Therapy and Secondary Prevention: Overview | Convalescent and Long-Term Antiplatelet Therapy | Beta Blockers | Inhibition Of The Renin-Angiotensin-Aldosterone System | Nitroglycerin Therapy | Calcium Channel Blockers | Warfarin Therapy | Lipid Management | Blood Pressure Control | Smoking Cessation | Weight Management | Physical Activity | Patient Education | Influenza | Depression | Nonsteroidal Anti-Inflammatory Drugs | Hormone Therapy | Antioxidant Vitamins and Folic Acid | Quality Care and Outcomes

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Contraindicated medications

Unstable angina is considered an absolute contraindication to the use of the following medications:

Case Studies

Case #1

Related Chapters

External Links


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