Unstable Angina/Non–ST Elevation Myocardial Infarction Ppt Powerpoint Presentation slides Anonymous Medical Slideshow Unstable Angina and Non ST elevation Myocardial Infarction

Unstable Angina/Non–ST Elevation Myocardial Infarction

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Slide 1 :

1 UA/NSTEMI Guidelines Slide Set ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction Developed In Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine

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2 Special Thanks to The UA/NSTEMI Guidelines Writing Committee Members Slide Set Editor Nanette Kass Wenger, MD, FACC, FAHA

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3 Applying Classification of Recommendations and Level of Evidence

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4 Applying Classification of Recommendations and Level of Evidence

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5 Overview of Acute Coronary Syndromes (ACS)

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6 Hospitalizations in the U.S. Due to ACS Acute Coronary Syndromes* 1.57 Million Hospital Admissions - ACS UA/NSTEMI† STEMI 1.24 million Admissions per year 0.33 million Admissions per year *Primary and secondary diagnoses. †About 0.57 million NSTEMI and 0.67 million UA. Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115:69–171.

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7 Libby P. Circulation 2001;104:365, Hamm CW, Bertrand M, Braunwald E, Lancet 2001; 358:1533-1538; Davies MJ. Heart 2000; 83:361-366. Anderson JL, et al. J Am Coll Cardiol. 2007;50:e1-e157, Figure 1. Reprinted with permission.

Slide 8 :

8 Causes of UA/NSTEMI* Thrombus or thromboembolism, usually arising on disrupted or eroded plaque Occlusive thrombus, usually with collateral vessels† Subtotally occlusive thrombus on pre-existing plaque Distal microvascular thromboembolism from plaque-associated thrombus Thromboembolism from plaque erosion Non–plaque-associated coronary thromboembolism Dynamic obstruction (coronary spasm‡ or vascoconstriction) of epicardial and/or microvascular vessels Progressive mechanical obstruction to coronary flow Coronary arterial inflammation Secondary UA Coronary artery dissection§ *These causes are not mutually exclusive; some patients have 2 or more causes. †DeWood MA, et al. N Engl J Med 1986;315:417–23. ‡May occur on top of an atherosclerotic plaque, producing missed-etiology angina or UA/NSTEMI. §Rare. Modified with permission from Braunwald E. Circulation 1998;98:2219–22. Anderson JL, et al. J Am Coll Cardiol. 2007;50:e1-e157, Table 3.

Slide 9 :

9 Management Before UA/NSTEMI and Onset of UA/NSTEMI

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10 Identification of Patients at Risk of UA/NSTEMI Primary care providers should evaluate the presence and status of control of major risk factors for coronary heart disease (CHD) for all patients at regular intervals (approximately every 3 to 5 years). Ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic CHD should be calculated for all patients who have 2 or more major risk factors to assess the need for primary prevention strategies (1,2). 1. Grundy SM, et al. Circulation 2004;110:227–39. 2. NCEP ATP III Final Report. Circulation 2002;106:3143–421. New Section

Slide 11 :

11 Identification of Patients at Risk of UA/NSTEMI Patients with established CHD should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., atherosclerosis in other vascular beds, diabetes mellitus, chronic kidney disease, or 10-year risk > 20% as calculated by Framingham equations) should receive equally intensive risk factor intervention as those with clinically apparent CHD. New Section

Slide 12 :

12 Initial Evaluation and Management of UA/NSTEMI

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