Infarto do miocárdio sem supradesnivelamento do segmento ST
Summary
Definition
History and exam
Key diagnostic factors
- dor torácica
- fatores de risco para doenças cardiovasculares
- sudorese acentuada
- choque cardiogênico
- insuficiência cardíaca aguda
Other diagnostic factors
- náuseas e vômitos
- arritmias
- bulhas cardíacas anormais
- dor epigástrica
- dispneia
- síncope
- dorsalgia
Risk factors
- tabagismo
- hipertensão
- diabetes
- obesidade e fenótipo de síndrome metabólica
- comportamento sedentário e inatividade física
- dislipidemia
- doença renal crônica
- aterosclerose (história de angina, infarto do miocárdio, AVC, ataque isquêmico transitório, doença vascular periférica)
- história familiar de doença arterial coronariana prematura
- idade >60 anos
- uso de cocaína
- depressão
- trombose de stent ou reestenose
- apneia do sono
- procedimentos cirúrgicos (incluindo os períodos intraoperatório e pós-operatório)
- enxaqueca
- desfechos adversos da gestação
Diagnostic tests
1st tests to order
- eletrocardiograma (ECG)
- troponina de alta sensibilidade
- ecocardiografia
- radiografia torácica
- hemograma completo
- ureia, eletrólitos e creatinina
- testes da função hepática
- glicose sanguínea
- proteína C-reativa
Tests to consider
- angiografia coronariana invasiva (ACI)
- lipídios
Treatment algorithm
características de risco muito alto ou alto risco (IAMSSST suspeito ou confirmado)
sem características de alto risco (IAMSSST suspeito ou confirmado)
Pós-IAMSSST
Contributors
Expert advisers
Shrilla Banerjee, MD, FRCP
Consultant Interventional Cardiologist
East Surrey Hospital
Surrey and Sussex Healthcare NHS Trust
UK
Disclosures
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
Disclosures
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
Disclosures
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.
Peer reviewers
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
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.
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