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Non-ST elevation coronary syndrome: Difference between revisions
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'''Non-ST elevation coronary syndrome''' (NSTE-ACS) is an umbrella term for '''non-ST elevation myocardial infarction''' (NSTEMI) and unstable angina. They're two forms of [[acute coronary syndrome]] characterised by the lack of ST elevations. | <section begin="A&IC" />'''Non-ST elevation coronary syndrome''' (NSTE-ACS) is an umbrella term for '''non-ST elevation myocardial infarction''' (NSTEMI) and unstable angina. They're two forms of [[acute coronary syndrome]] characterised by the lack of ST elevations. | ||
An '''non-ST elevation myocardial infarction''' (NSTEMI) is a clinical form of [[acute myocardial infarction]] and one form of [[acute coronary syndrome]]. It is defined as the presence of ischaemic symptoms, lack of ST-elevations in a pattern consistent with the blood supply of one coronary artery and a rise and/or fall in [[troponin]] levels. Ischaemic symptoms are classically [[Chest pain|angina]], but may also be dyspnoea, nausea, sweating, anxiety, or non-anginal chest pain. For initial evaluation, see [[acute coronary syndrome]]. | An '''non-ST elevation myocardial infarction''' (NSTEMI) is a clinical form of [[acute myocardial infarction]] and one form of [[acute coronary syndrome]]. It is defined as the presence of ischaemic symptoms, lack of ST-elevations in a pattern consistent with the blood supply of one coronary artery and a rise and/or fall in [[troponin]] levels. Ischaemic symptoms are classically [[Chest pain|angina]], but may also be dyspnoea, nausea, sweating, anxiety, or non-anginal chest pain. <section end="A&IC" />For initial evaluation, see [[acute coronary syndrome]]. | ||
'''Unstable angina''' is defined as the presence of ischaemic symptoms in rest without an elevation of troponin levels beyond the upper normal level. If the occlusion is severe enough to cause ischaemia (and resulting symptoms) but not severe enough to cause infarction, the result is unstable angina. | '''Unstable angina''' is defined as the presence of ischaemic symptoms in rest without an elevation of troponin levels beyond the upper normal level. If the occlusion is severe enough to cause ischaemia (and resulting symptoms) but not severe enough to cause infarction, the result is unstable angina. | ||
<section begin="A&IC" /> | |||
== ECG changes == | == ECG changes == | ||
While ST-elevations are never present in NSTE-ACS (in which case it would be a [[ST-elevation myocardial infarction|STEMI]]), other ECG changes may be present, like ST-depression or T wave inversion. In unstable angina, these changes are transient. ECG changes are a negative prognostic sign. | While ST-elevations are never present in NSTE-ACS (in which case it would be a [[ST-elevation myocardial infarction|STEMI]]), other ECG changes may be present, like ST-depression or T wave inversion. In unstable angina, these changes are transient. ECG changes are a negative prognostic sign.<section end="A&IC" /> | ||
It's important to know that unlike ST elevation, ST depression cannot localise the lesion. This means that ST depression in for example "inferior leads" (II, III, aVF) does not indicate that the NSTEMI is localised to the inferior leads. | It's important to know that unlike ST elevation, ST depression cannot localise the lesion. This means that ST depression in for example "inferior leads" (II, III, aVF) does not indicate that the NSTEMI is localised to the inferior leads. | ||
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== Initial management == | == Initial management == | ||
The decision of whether to go for an invasive ([[Percutaneous coronary intervention|PCI]]) or conservative (only drugs) management of NSTE-ACS depends on the patient’s risk stratification. This risk stratification should be done as early as possible. The higher the risk, the sooner they should undergo PCI. Generally, the urgency is evaluated like this: | The decision of whether to go for an invasive ([[Percutaneous coronary intervention|PCI]]) or conservative (only drugs) management of NSTE-ACS depends on the patient’s risk stratification. This risk stratification should be done as early as possible. The higher the risk, the sooner they should undergo PCI. Generally, the urgency is evaluated like this: | ||
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* [[Morphine]] – in case of chest pain not responsive to nitro | * [[Morphine]] – in case of chest pain not responsive to nitro | ||
* [[Oxygen]] – in case of O2 sat < 90% | * [[Oxygen]] – in case of O2 sat < 90% | ||
<section end="A&IC" /> | |||
==Secondary prevention== | ==Secondary prevention== | ||
See [[secondary prevention of ischemic heart disease]]. | See [[secondary prevention of ischemic heart disease]]. | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||