Acute Coronary Syndromes: NSTE-ACS (Unstable Angina and NSTEMI)

Harish C. Devineni, MD, Mahesh Anantha Narayanan, MD and Venkata M. Alla, MD Reviewed 06/2017
 


BASICS

DESCRIPTION

  • Unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) are acute coronary syndromes (ACS) without ST-segment elevation (NSTE-ACS).

  • NSTEMI is defined by a ris...

DIAGNOSIS

HISTORY

  • Chest heaviness/tightness lasting ≥0 minutes; occurs with or without exertion and can increase in frequency

  • Pain or discomfort is typically retrosternal and can radiate to the neck, ja...

TREATMENT

GENERAL MEASURES

  • Risk stratify using the TIMI or GRACE score to select use of early invasive approach (within 12 to 24 hours of admission) versus ischemia-guided therapy.

    • ▪ Invasive management...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • It is reasonable in patients with suspected ACS (low risk) who have normal serial ECGs and cardiac troponins to have a treadmill ECG, stress myocardial perfusion ...

REFERENCES

Anderson  JL, Adams  CD, Antman  EM, et al. 2012 ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation ...

ADDITIONAL READING

  • Hoenig MR, Aroney CN, Scott IA. Early invasive versus conservative strategies for unstable angina and non-ST elevation myocardial infarction in the stent era. Cochrane Database Syst...

CODES

ICD10

  • I24.9 Acute ischemic heart disease, unspecified

  • I20.0 Unstable angina

  • I21.4 Non-ST elevation (NSTEMI) myocardial infarction

ICD9

  • 411.1 Intermediate coronary syndrome

  • 410.70 Subendocardial infarc...

CLINICAL PEARLS

  • Discontinue NSAIDs, nonselective, or selective cyclooxygenase (COX)-2 agents, except for ASA due to increased risks of mortality, reinfarction, hypertension, heart failure, and myocard...

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