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Infarto do miocárdio sem supradesnivelamento do segmento ST

Última revisão: 9 Apr 2025
Última atualização: 25 Jul 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • dor torácica
  • diaforese
Detalhes completos

Outros fatores diagnósticos

  • dispneia
  • fraqueza
  • ansiedade
  • náuseas e vômitos
  • dor abdominal
  • hipertensão
  • aparecimento no começo da manhã
  • síncope
  • hipotensão
  • arritmias
  • bulhas cardíacas anormais
Detalhes completos

Fatores de risco

  • aterosclerose (história de angina, infarto do miocárdio, AVC, ataque isquêmico transitório, doença vascular periférica)
  • diabetes
  • tabagismo
  • dislipidemia
  • história familiar de doença arterial coronariana (DAC) prematura
  • idade >65 anos
  • hipertensão
  • obesidade e fenótipo de síndrome metabólica
  • sedentarismo
  • uso de cocaína
  • depressão
  • trombose de stent ou reestenose
  • doença renal crônica
  • procedimentos cirúrgicos (incluindo os períodos intraoperatório e pós-operatório)
  • apneia do sono
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • eletrocardiograma (ECG)
  • biomarcadores cardíacos
  • ecocardiografia
  • Hemograma completo
  • ureia e creatinina sérica
  • eletrólitos
  • TFHs
  • glicose sanguínea
  • radiografia torácica
Detalhes completos

Investigações a serem consideradas

  • lipídios
  • peptídeo natriurético do tipo B (PNB) ou pró-peptídeo natriurético do tipo B N-terminal (NT-proPNB)
  • angiografia/cateterismo cardíaco
  • teste ergométrico
  • angiotomografia coronária (ATC)
Detalhes completos

Algoritmo de tratamento

AGUDA

apresentação aguda

CONTÍNUA

após a estabilização

Colaboradores

Authors

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

Disclosures

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

Disclosures

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.

Acknowledgements

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.

Disclosures

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.

Peer reviewers

Syed Wamique Yusuf, MBBS, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

Disclosures

SWY declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Infarto do miocárdio sem supradesnivelamento do segmento ST images
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    • Infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST)
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  • Guidelines

    • Non-invasive imaging in coronary syndromes
    • 2021 ACC/AHA/SCAI guideline for coronary artery revascularization
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  • Patient information

    Heart attack: what is it?

    What you can do to prevent another heart attack

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  • Calculators

    ASCVD Risk Estimator Plus

    Escore do Thrombolysis in Myocardial Infarction (TIMI) para infarto do miocárdio sem supradesnivelamento do segmento ST com angina instável

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