Non-ST-elevation myocardial infarction
小结
定义
病史和体格检查
关键诊断因素
- chest pain
- risk factors for cardiovascular disease
- marked sweating
- cardiogenic shock
- acute heart failure
其他诊断因素
- nausea and vomiting
- arrhythmias
- Abnormal heart sounds
- epigastric pain
- dyspnoea
- syncope
- back pain
危险因素
- smoking
- hypertension
- diabetes
- obesity and metabolic syndrome phenotype
- sedentary behaviour and physical inactivity
- dyslipidaemia
- chronic kidney disease
- atherosclerosis (history of angina, myocardial infarction, stroke, transient ischaemic attack, peripheral vascular disease)
- family history of premature coronary artery disease
- age >60 years
- cocaine use
- depression
- stent thrombosis or restenosis
- sleep apnoea
- surgical procedures (including intra-operative and postoperative periods)
- migraine
- adverse pregnancy outcomes
诊断性检查
首要检查
- ECG
- high-sensitivity troponin
- echocardiography
- chest x-ray
- full blood count
- urea, electrolytes, and creatinine
- liver function tests
- blood glucose
- C-reactive protein
需考虑的检查
- invasive coronary angiography (ICA)
- lipids
治疗流程
very high-risk or high-risk features (suspected or confirmed NSTEMI)
no high-risk features (suspected or confirmed NSTEMI)
post-NSTEMI
撰稿人
专家顾问
Shrilla Banerjee, MD, FRCP
Consultant Interventional Cardiologist
East Surrey Hospital
Surrey and Sussex Healthcare NHS Trust
UK
利益声明
SB has received speaker fees for educational lectures (presentation content was her own) and meeting participation from Menarini, Edwards Lifesciences, Abbott Vascular, and Shockwave IVL. She has also participated in an Advisory Board for Sahajanand Medical Technologies Limited. SB has received travel sponsorship from Biosensors International to attend the PCR meeting in Paris in 2022. She has prepared a manuscript on coronary microvascular dysfunction for Abbott for Cardiovascular News (no royalties).
Adam Hartley, MBBS, BSc, MRCP
Wellcome Trust Clinical Research Fellow
Imperial College London
Specialist Registrar in Cardiology
Imperial College Healthcare NHS Trust
London
UK
利益声明
AH declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:
Resham Baruah MBBS, BSc MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
London
UK
Cody S Deen, MD
Assistant Professor of Medicine
Director of Cardiology
Hillsborough Hospital
University of North Carolina
Hillsborough
NC
利益声明
RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim. CSD was previously the Director of Cardiac Rehab for Chatham Hospital, which was financially set up as a consultancy relationship, until 2017. CSD has spoken (unpaid) at the Update in Cardiology and Update in Internal Medicine Conferences at UNC for the last 5 years. CSD has served as the PI for the Dal-GeneE (site now closed) and the ACCELERATE Trials at the University of North Carolina (trial now completed). Each trial required paid travel to an investigator meeting.
同行评议者
Gavin Galasko, BM, BCh, MA, DM (Oxon), FRCP
Consultant Interventional Cardiologist
Director of Research, Development and Innovation
Blackpool Teaching Hospitals NHS Foundation Trust
Blackpool
UK
Disclosures
GG declares that he has no competing interests.
References
Key articles
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-228.Full text Abstract
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023 Oct 12;44(38):3720-826.Full text Abstract
National Institute for Health and Care Excellence. Acute coronary syndromes. Nov 2020 [internet publication].Full text
National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis. Nov 2016 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- ST-elevation myocardial infarction
- Unstable angina
- Aortic dissection
More DifferentialsGuidelines
- ESC guidelines for the management of acute coronary syndromes
- Acute coronary syndromes
More GuidelinesCalculators
GRACE Score for Acute Coronary Syndrome Prognosis
Thrombolysis in Myocardial Infarction (TIMI) Score for Unstable Angina Non ST Elevation Myocardial Infarction
More CalculatorsVideos
How to perform an ECG animated demonstration
More videosPatient information
Heart attack: what is it?
What you can do to prevent another heart attack
More Patient information
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer