Angina

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Learn and Live

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ACC/AHA Pocket Guideline
Based on the ACC/AHA 2007 Guideline Revision

Management of Patients With

Unstable Angina/ Non–ST-Elevation Myocardial Infarction

October 2007

Special thanks to

Distributed with the support of sanofi-aventis U.S. Inc. sanofi-aventis U.S. Inc. was not involved in the development of this publication and in no way influenced itscontent.

Management of Patients With

Unstable Angina/ Non–ST-Elevation Myocardial Infarction
October 2007
ACC/AHA Writing Committee
Jeffrey L. Anderson, MD, FACC, FAHA, Chair Cynthia D. Adams, RN, PhD, FAHA Elliott M. Antman, MD, FACC, FAHA Charles R. Bridges, MD, ScD, FACC, FAHA Robert M. Califf, MD, MACC Donald E. Casey, MD, MPH, MBA, FACP William E. Chavey, MD, MS Francis M. Fesmire, MD,FACEP Judith S. Hochman, MD, FACC, FAHA Thomas N. Levin, MD, FACC, FSCAI A. Michael Lincoff, MD, FACC Eric D. Peterson, MD, MPH, FACC, FAHA Pierre Theroux, MD, FACC, FAHA Nanette Kass Wenger, MD, FACC, FAHA R. Scott Wright, MD, FACC, FAHA

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Initial E/M

© 2007 American College of Cardiology Foundation and American Heart Association, Inc. The following material was adapted from theACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. For a copy of the executive summary (J Am Coll Cardiol 2007;50:652–726; Circulation 2007;116:803–877) and

Hospital Care

full report, visit our Web sites at http://www.acc.org or http://www.americanheart.org or call the ACC Resource Center at 1-800-253-4636, ext. 5603.Discharge/Post-Discharge

Revascularization

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Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

I. Initial Evaluation and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
A. Clinical Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 B. EarlyRisk Stratification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 C. Immediate Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Initial E/M

II. Early Hospital Care

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Hospital Care

A. Anti-Ischemic Therapy . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 B. Initial Conservative Versus Initial Invasive Strategies . . . . . . . . . . . . . . . . . 15 C. Antiplatelet and Anticoagulant Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 D. Risk Stratification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

III.Coronary Revascularization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Revascularization Discharge/Post-Discharge

IV. Hospital Discharge and Post-Hospital Discharge Care

. . . . . . . . 34

A. Post-Discharge Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 B. Long-Term Medical Therapy and Secondary Prevention . . . .. . . . . . . . . . . 36

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Introduction
Coronary artery disease (CAD) is the leading cause of death in the United States. Unstable angina (UA) and the closely related condition non–ST-segment elevation myocardial infarction (NSTEMI) are very common manifestations of this disease and are responsible for approximately 1.5 million hospitalizations in the United States each year. UA andNSTEMI are examples of acute coronary syndrome (ACS), which is characterized by an imbalance between myocardial oxygen supply and demand. The most common cause is the reduced myocardial perfusion that results from coronary artery narrowing caused by a nonocclusive thrombus that has developed on a disrupted atherosclerotic plaque. UA and NSTEMI are considered to be closely related conditions whose...
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