![]() AHA recommends for moderate & high risk Unstable angina/NSTEMI unless CABG within 24hr.Give heparin or enoxaparin along with ASA (Class 1A evidence).Administer at time of PCI, not in the ED.Benefit only for patients undergoing PCI.Main risk and contraindication is bleeding.Mortality benefit with NSTEMI (CURE trial: Decrease in cardiovascular death, MI, or stroke by 9.3-11.5%).Clopidogrel (see drug link for specific age and indication-related dosages).In pts with true ASA allergies, substitute Clopidogrel.Should be used in all ACS unless contraindicated (eg Anaphylaxis).Medical management vs cath determined by level of risk for future cardiovascular events.Dual antiplatelet therapy and antithrombotic therapy is mainstay of treatment.High-risk findings on noninvasive stress testing.New or presumably new ST-segment depression.Recurrent angina/ischemia with or with out symptoms of CHF.Esophageal perforation (Boerhhaave's syndrome).More likely to report central chest painįactors associated with delayed presentation ĭifferential Diagnosis Chest pain Critical.More likely to report fatigue, dyspnea, indigestion, nausea or vomiting, palpitations, or weakness, although some studies have found fewer differences in presentation.Less likely to receive timely reperfusion therapy.Less likely to undergo cardiac catheterization.Less likely to be treated with guideline-directed medical therapies.Chest pain associated with nausea/vomitingĬlinical factors that decrease likelihood of ACS/AMI:.Chest pain radiating to both arms > R arm > L arm.Type 5: Myocardial Infarction Related to CABG ProcedureĬlinical factors that increase likelihood of ACS/AMI:.Type 4: Myocardial Infarction Associated With Revascularization Procedure.Sudden cardiac death with symptoms suggestive of myocardial ischaemia without elevated biomarkers.Type 3: Cardiac Death Due to Myocardial Infarction.coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias) Condition other than CAD contributes to an imbalance between myocardial oxygen supply and/or demand (e.g.Type 2: Myocardial Infarction Secondary to an Ischemic Imbalance.Atherosclerotic plaque rupture or intraluminal thrombus in one or more of the coronary arteries.Type 1: Spontaneous Myocardial Infarction.NSTEMI includes Type 2 -Type 5 biomarker elevations.Association between quantity of troponin and risk of death.Age >65 with MI and anemia had 33% reduction in 30 day mort if transfused to keep HCT >30.5% of NSTEMI will develop Cardiogenic Shock (60% mortality).33% with confirmed MI have no chest pain on presentation (especially older, female, DM, CHF).5.4 Unstable Angina - NSTEMI Guidelines.Severity of coronary artery disease (CAD) on angiography: no significant CAD: 35%, one-vessel CAD: 28%, two-vessel disease: 20%, three-vessel disease: 17%, acute thrombotic lesion: 5%.Median Glasgow Coma Score (GCS) on admission: 3. ![]() Median time from arrest to ROSC: 15 minutes.Obvious noncoronary cause of the arrest.ST-segment elevation myocardial infarction (STEMI).No ST-segment elevation on ECG post-ROSC.Targeted temperate management was initiated as soon as possible. The intent of angiography was to revascularize any possible culprit lesions, either with PCI or coronary artery bypass grafting. Median times to angiography post-arrest were 2.3 hours for emergent vs. In the delayed arm, coronary angiography was performed after neurological recovery, in general after the patient was moved out of the intensive care unit. Eligible patients were randomized in a 1:1 fashion to either emergent angiography (n = 273) or delayed angiography (n = 265).
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