12/14/2023 0 Comments Timi score cad risk factor![]() ![]() STEMI) is determined based on ECG findings. Unstable angina is differentiated from MI by the presence of positive troponins, while the type of MI ( NSTEMI vs. Subtypes of ACS cannot be differentiated based on clinical presentation alone. See “ Acute management checklist for STEMI.”.Adjunctive medical therapy similar to NSTE-ACS.See “ Acute management checklist for NSTE-ACS.”.Anticoagulants, antiplatelet therapy (e.g., aspirin, ADP receptor inhibitors).Invasive management depends on risk stratification (e.g., TIMI score).ST elevations (in two contiguous leads) or new left bundle branch block with strong clinical suspicion of myocardial ischemia.Normal or nonspecific (e.g., ST depression, loss of R wave, T-wave inversion).Affects the full thickness of the myocardium ( transmural infarction).Classically due to complete occlusion of a coronary artery.Affects the inner layer of the heart ( subendocardial infarction).Classically due to partial occlusion of a coronary artery.Partial occlusion of coronary vessel → decreased blood supply → ischemic symptoms without infarction.Autonomic symptoms may be present: diaphoresis, syncope, palpitations, nausea, and/or vomiting.Severe, persistent, and/or worsening ( crescendo angina).Occurring at rest/with minimal exertion and is usually not relieved by rest or nitroglycerin.Symptoms are not reproducible/predictable.Acute myocardial ischemia that is severe enough to cause ST-segment elevations on ECG.Acute myocardial ischemia that is severe enough to cause detectable quantities of myocardial injury biomarkers but without ST-segment elevations on ECG.Acute myocardial ischemia that is not severe enough to cause detectable quantities of myocardial injury biomarkers or ST-segment elevations on ECG.ST-segment elevation myocardial infarction ( STEMI) Non-ST-segment elevation myocardial infarction ( NSTEMI) Overview of acute coronary syndrome ( ACS) See “ Myocardial infarction” for more details regarding, e.g., histopathology and long-term management. This article concerns the initial management of ACS patients. Adjunctive therapy (e.g., beta blockers, oxygen) helps reduce symptoms and can have a positive impact on mortality. All ACS patients receive dual antiplatelet therapy and initially anticoagulation. The timing and necessity of revascularization therapy in NSTE-ACS is determined based on multiple risk factors. STE-ACS patients require immediate revascularization therapy with percutaneous coronary intervention ( PCI) or fibrinolytic therapy. Depending on serum levels of cardiac troponin (cTn), NSTE-ACS can be categorized as NSTEMI or unstable angina (UA). Based on ECG findings, patients are categorized into those with ST-elevation ( STE-ACS) or non- ST-elevation ACS ( NSTE-ACS). Clinical findings (e.g., onset and characteristics of pain, patient history) in combination with ECG and troponin are the mainstays of diagnosis. doi:10.1161/ coronary syndrome ( ACS) is the clinical manifestation of myocardial infarct and commonly the default working diagnosis in patients with new-onset chest pain suspected to be of cardiac ischemic origin. Cardiovascular system in preeclampsia and beyond. Chronic kidney disease and cardiovascular disease: is there any relationship? Curr Cardiol Rev. Vallianou NG, Mitesh S, Gkogkou A, Geladari E. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds risk score. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses. Performance of the Framingham risk models and pooled cohort equations for predicting 10-year risk of cardiovascular disease: a systematic review and meta-analysis. doi:10.1371/journal.pone.0096368ĭamen JA, Pajouheshnia R, Heus P, Moons KGM, Reitsma JB, Scholten JPM, Hoof L, Debray TPA. Cigarette smoking exacerbates the adverse effects of age and metabolic syndrome on subclinical atherosclerosis: the bogalusa heart study. Determinants of vascular age: an epidemiological perspective. Kucharska-Newton AM, Stoner L, Meyer Michelle L. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Detection, evaluation, and treatment, of high cholesterol in adults (Adult Treatment Panel III).ĭ'Agostino RB Sr, Vasan RS, Pencina MJ, et al. Prediction of coronary heart disease using risk factor categories. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. About the Framingham heart study.Ĭenters for Disease Control and Prevention. ![]()
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