Acute coronary syndrome: Difference between revisions
Jump to navigation
Jump to search
imported>Robert Badgett No edit summary |
imported>Robert Badgett (Added diagnosis and prognosis sections.) |
||
| Line 6: | Line 6: | ||
{{main|Myocardial infarction}} | {{main|Myocardial infarction}} | ||
A myocardial infarction is defined as "gross necrosis of the myocardium, as a result of interruption of the blood supply to the area".<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=unstable+angina |title=Myocardial infarction|author=National Library of Medicine |accessdate=2007-10-28 |format= |work=}}</ref> | A myocardial infarction is defined as "gross necrosis of the myocardium, as a result of interruption of the blood supply to the area".<ref>{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&term=unstable+angina |title=Myocardial infarction|author=National Library of Medicine |accessdate=2007-10-28 |format= |work=}}</ref> | ||
==Diagnosis== | |||
The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI), a [[clinical prediction rule]], can help diagnose patients with chest pain.<ref name="pmid9867725">{{cite journal |author=Selker HP, Beshansky JR, Griffith JL, ''et al'' |title=Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial |journal=Ann. Intern. Med. |volume=129 |issue=11 |pages=845–55 |year=1998 |pmid=9867725 |doi=}}</ref> | |||
==Treatment== | ==Treatment== | ||
[[Clinical practice guideline]]s address the treatment of unstable angina and non-ST-elevation [[myocardial infarction]].<ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |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=J. Am. Coll. Cardiol. |volume=50 |issue=7 |pages=e1–e157 |year=2007 |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013}}</ref> | [[Clinical practice guideline]]s address the treatment of unstable angina and non-ST-elevation [[myocardial infarction]].<ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, ''et al'' |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=J. Am. Coll. Cardiol. |volume=50 |issue=7 |pages=e1–e157 |year=2007 |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013}}</ref> | ||
==Prognosis== | |||
The Thrombolysis in Myocardial Infarction [TIMI] [[clinical prediction rule]] can predict the likelihood of morbidity in patients with unstable angina or NSTEMI.<ref name="pmid10938172">{{cite journal |author=Antman EM, Cohen M, Bernink PJ, ''et al'' |title=The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making |journal=JAMA |volume=284 |issue=7 |pages=835–42 |year=2000 |pmid=10938172 |doi=|url=http://jama.ama-assn.org/cgi/content/full/284/7/835}}</ref> The TIMI risk score is: | |||
* Age 65 years or older | |||
* At least 3 risk factors for coronary artery disease (family history or [[coronary disease]], [[hypertension]], [[hypercholesterolemia]], [[diabetes]], current smoking) | |||
* Prior coronary stenosis of 50% or more | |||
* ST-segment deviation on electrocardiogram at presentation | |||
* At least 2 anginal events in prior 24 hours | |||
* Use of aspirin in prior 7 days | |||
* Elevated serum cardiac markers | |||
==References== | ==References== | ||
Revision as of 11:35, 28 November 2007
Classification
Unstable angina
Unstable angina is defined as "precordial pain at rest, which may precede a myocardial infarction".[1]
Myocardial infarction
A myocardial infarction is defined as "gross necrosis of the myocardium, as a result of interruption of the blood supply to the area".[2]
Diagnosis
The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI), a clinical prediction rule, can help diagnose patients with chest pain.[3]
Treatment
Clinical practice guidelines address the treatment of unstable angina and non-ST-elevation myocardial infarction.[4]
Prognosis
The Thrombolysis in Myocardial Infarction [TIMI] clinical prediction rule can predict the likelihood of morbidity in patients with unstable angina or NSTEMI.[5] The TIMI risk score is:
- Age 65 years or older
- At least 3 risk factors for coronary artery disease (family history or coronary disease, hypertension, hypercholesterolemia, diabetes, current smoking)
- Prior coronary stenosis of 50% or more
- ST-segment deviation on electrocardiogram at presentation
- At least 2 anginal events in prior 24 hours
- Use of aspirin in prior 7 days
- Elevated serum cardiac markers
References
- ↑ National Library of Medicine. Unstable angina. Retrieved on 2007-10-28.
- ↑ National Library of Medicine. Myocardial infarction. Retrieved on 2007-10-28.
- ↑ Selker HP, Beshansky JR, Griffith JL, et al (1998). "Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial". Ann. Intern. Med. 129 (11): 845–55. PMID 9867725. [e]
- ↑ 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". J. Am. Coll. Cardiol. 50 (7): e1–e157. DOI:10.1016/j.jacc.2007.02.013. PMID 17692738. Research Blogging.
- ↑ Antman EM, Cohen M, Bernink PJ, et al (2000). "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making". JAMA 284 (7): 835–42. PMID 10938172. [e]