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

Keith Ranney Love, MD, BA, Alejandro Folch Sandoval, MD and Colleen Mary Harrington, Medical Doctor Reviewed 06/2022
 


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. Pain or discomfort is typically retrosternal and can radiate to the neck, jaw, interscapular area, uppe...

TREATMENT

GENERAL MEASURES

  • Risk stratify (TIMI or GRACE score) to select use of early invasive approach (coronary angiography within 24 hours of admission) versus ischemia-guided therapy. Urgent invasi...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Patients with low-risk suspected ACS who have normal serial ECGs and cardiac troponins may have a treadmill ECG, stress myocardial perfusion imaging, or stress ec...

REFERENCES

1
Collet JP, Cuisset T, Rangé G, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med. 2012; 367:2100.
2
Benjamin EJ, Virani SS, Callaway CW, et al; Ame...

CODES

ICD10

  • I24.9 Acute ischemic heart disease, unspecified

  • I20.0 Unstable angina

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

SNOMED

  • 394659003 Acute coronary syndrome (disorder)

  • 4557003 Preinfarct...

CLINICAL PEARLS

  • ​​​​Dual anti-platelet therapy, antithrombotic therapy, β-blocker, high-dose statin therapy, and nitrates are the cornerstones of initial therapy and should be initiated promptly.

  • Durat...

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