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

Aravdeep Jhand, MBBS, Harish C. Devineni, MD and Gene Pershwitz, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

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

  • NSTEMI is defined by the rise an...

DIAGNOSIS

HISTORY

  • Chest heaviness/tightness lasting ≥10 minutes; occurs with or without exertion, may increase in frequency

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

TREATMENT

GENERAL MEASURES

  • Risk stratify using TIMI or GRACE score to select use of early invasive approach (coronary angiography within 24 hours of admission) versus ischemia-guided therapy (3)[A]

    • Ur...

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 (3)[A], stress myocardial per...

REFERENCES

1 Anderson JL, Adams CD, Antman EM, et al; for American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2012 ACCF/AHA focused update incorpor...

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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