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

Reviewed 06/2020
 


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, ja...

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

    • Urgent inva...

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

1
Benjamin EJ, Virani SS, Callaway CW, et al; for American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and...

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 acetylsalicylic acid, due to increased risks of mortality, reinfarction, hypertension, heart fai...

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