PMID- 20669821
OWN - NLM
STAT- MEDLINE
DCOM- 20110210
LR  - 20100730
IS  - 0032-6518 (Print)
IS  - 0032-6518 (Linking)
VI  - 254
IP  - 1730
DP  - 2010 Jun
TI  - Managing unstable angina and non-ST elevation MI.
PG  - 25-30, 2-3
AB  - Acute coronary syndrome (ACS), encompassing unstable angina (UA), non-ST 
      elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction 
      (STEMI), is often the result of an acute thrombotic occlusion of the coronary 
      vessels, associated with atheromatous plaque rupture or erosion. ACS is 
      associated with a severely impaired prognosis and requires prompt and efficient 
      specialist treatment. The clinical presentation may be identical across all three 
      components of ACS. Establishing an accurate diagnosis without delay is of 
      paramount importance to start treatment promptly. Patients with suspected ACS 
      need to be referred immediately to A&E. Prehospital treatment, which includes 
      aspirin, nitrates, morphine and oxygen (if hypoxic), should be initiated rapidly. 
      Important features pointing towards a diagnosis of ACS include: typical 
      characteristics of chest pain, presence of risk factors, and ECG changes 
      suggestive of myocardial ischaemia. Chest discomfort in patients with ACS 
      typically occurs at rest, is anginal in character and can range from mild 
      tightness to central crushing chest pain. It may be associated with nausea, 
      dyspnoea or diaphoresis. The chest pain may radiate to the arms, back or jaw and 
      is often >20 minutes in duration. An accurate clinical history and a detailed 
      examination are vital. Initial investigations are the same for all ACS events, 
      with the need for urgent serial ECGs and the measurement of cardiac troponin 
      levels, to assess myocardial damage. In NSTEMI, ECG changes suggestive of 
      ischaemia are often present and associated with elevated cardiac troponin. In UA, 
      there is a considerable reduction in myocardial perfusion leading to symptoms; 
      but there is no rise in cardiac troponin. Risk stratification is imperative in 
      assessment of ACS to allow efficient delivery of specialist care. Treatment 
      includes: antiplatelets; antithrombotic agents; angina drugs; analgesia, and PCI.
FAU - Akhtar, Mohammed Majid
AU  - Akhtar MM
AD  - Southend University Hospital NHS Trust.
FAU - Iqbal, Yassir Hassan
AU  - Iqbal YH
FAU - Kaski, Juan Carlos
AU  - Kaski JC
LA  - eng
PT  - Journal Article
PL  - England
TA  - Practitioner
JT  - The Practitioner
JID - 0404245
RN  - 0 (Analgesics)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Vasodilator Agents)
SB  - IM
MH  - Analgesics/therapeutic use
MH  - Angina, Unstable/diagnosis/*therapy
MH  - Electrocardiography
MH  - Fibrinolytic Agents/therapeutic use
MH  - Humans
MH  - Myocardial Infarction/*therapy
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Risk Factors
MH  - Vasodilator Agents/therapeutic use
EDAT- 2010/07/31 06:00
MHDA- 2011/02/11 06:00
CRDT- 2010/07/31 06:00
PHST- 2010/07/31 06:00 [entrez]
PHST- 2010/07/31 06:00 [pubmed]
PHST- 2011/02/11 06:00 [medline]
PST - ppublish
SO  - Practitioner. 2010 Jun;254(1730):25-30, 2-3.