Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
- dolor torácico
- diaforesis
Otros factores de diagnóstico
- disnea
- debilidad
- ansiedad
- náuseas y vómitos
- dolor abdominal
- hipertensión
- presentación temprano en la mañana
- síncope
- hipotensión
- arritmias
- ruido cardíaco anormal
Factores de riesgo
- aterosclerosis (antecedentes de angina, infarto de miocardio, accidente cerebrovascular, accidente isquémico transitorio, enfermedad vascular periférica)
- diabetes
- tabaquismo
- dislipidemia
- antecedentes familiares de arteriopatía coronaria (AC) prematura
- edad >65 años
- hipertensión
- obesidad y fenotipo del síndrome metabólico
- inactividad física
- consumo de cocaína
- depresión
- trombosis del stent o reestenosis
- enfermedad renal crónica
- procedimientos quirúrgicos (incluidos períodos intraoperativos y postoperativos)
- apnea del sueño
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- electrocardiograma (ECG)
- biomarcadores cardíacos
- ecocardiografía
- hemograma completo (HC)
- urea y creatinina sérica
- electrolitos
- pruebas de función hepática (PFH)
- glucemia
- radiografía de tórax
Pruebas diagnósticas que deben considerarse
- lípidos
- péptido natriurético cerebral (PNC) o N-terminal pro-PNC (NT-pro-PNC)
- angiografía/cateterismo cardíaco
- pruebas de esfuerzo
- angiografía coronaria por tomografía computarizada (ACTC)
Algoritmo de tratamiento
presentación aguda
después de la estabilización
Colaboradores
Autores
Mahi L. Ashwath, MD, MBA, FACC, FASE, FSCMR
Director, Cardiac MRI
Clinical Professor of Medicine and Radiology
Division of Cardiology
Department of Internal Medicine
University of Iowa Hospitals and Clinics
University of Iowa Health Care
Iowa
IA
Divulgaciones
MLA declares that she is a member of the Board of Governors of the American College of Cardiology.
Sanjay Gandhi, MD, MBA, FACC, FAHA, FSCAI
Director, Endovascular Cardiology
Professor of Medicine, Endovascular Cardiology
Case Western Reserve University
Cleveland
OH
Divulgaciones
SG declares that he is Senior Director of Medical Strategy and Innovation for the US market at Philips. SG is a senior advisor at Emeritus. SG is a voluntary board member of the American College of Cardiology (ACC) National Cardiovascular Data Registry oversight committee, the Chest Pain Myocardial Infarction registry steering committee, and the ACC finance committee.
Agradecimientos
Dr Mahi L. Ashwath and Dr Sanjay Gandhi would like to gratefully acknowledge Dr Cody Deen, Dr Sripal Bangalore, Dr Mina Owlia, Dr Thomas Vanhecke, and Dr Dena Krishnan, the previous contributors to this topic.
Divulgaciones
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. SB, MO, TV, and DK declare that they have no competing interests.
Revisores por pares
Syed Wamique Yusuf, MBBS, FRCPI
Professor of Medicine
Department of Cardiology
University of Texas
MD Anderson Cancer Center
Houston
TX
Divulgaciones
SWY declares that he has no competing interests.
Referencias
Artículos principales
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.Texto completo Resumen
Thygesen K, Alpert JS, Jaffe AS, et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol. 2018 Oct 30;72(18):2231-64.Texto completo Resumen
Collet JP, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021 Apr 7;42(14):1289-367.Texto completo Resumen
Writing Committee Members; Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee On Clinical Practice Guidelines. J Am Coll Cardiol. 2021 Nov 30;78(22):e187-285.Texto completo Resumen
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee On Clinical Practice Guidelines. Circulation. 2022 Jan 18;145(3):e18-114.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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- 2021 ACC/AHA/SCAI guideline for coronary artery revascularization
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