小结
定义
病史和体格检查
关键诊断因素
- 胸痛
- 心血管疾病危险因素
- 大量出汗
- 心源性休克
- 急性心力衰竭
其他诊断因素
- 恶心和呕吐
- 心律失常
- 心脏杂音
- 上腹痛
- 呼吸困难
- 晕厥
- 背痛
危险因素
- 吸烟
- 高血压
- 糖尿病
- 肥胖及代谢综合征的表型
- 久坐行为和身体活动不足
- 血脂异常
- 慢性肾病
- 动脉粥样硬化(心绞痛、心肌梗死、卒中、短暂性脑缺血发作和外周血管疾病史)
- 早发冠状动脉病变家族史
- 年龄 60 岁以上
- 使用可卡因
- 抑郁症
- 支架内血栓形成或再狭窄
- 睡眠呼吸暂停
- 手术治疗(包括手术期间及手术后期)
诊断性检查
首要检查
- 心电图(ECG)
- 高敏肌钙蛋白
- 胸部 X 线检查
- 全血细胞计数
- 尿素、电解质和肌酐
- 肝功能检测
- 血糖
- C 反应蛋白
需考虑的检查
- 超声心动图
- 有创性冠状动脉血管造影术(invasive coronary angiography, ICA)
治疗流程
极高危或高危特征(疑似或证实 NSTEMI)
无高危特征(疑似或证实 NSTEMI)
NSTEMI 后
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
利益声明
GG declares that he has no competing interests.
编辑
Annabel Sidwell
Section Editor, BMJ Best Practice
利益声明
AS declares that she has no competing interests.
Susan Mayor
Lead Section Editor, BMJ Best Practice
利益声明
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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