Acute Coronary Syndrome

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Causes of UA/NSTEMI* • Thrombus or thromboembolism, usually arising on disrupted or eroded plaque • Occlusive thrombus, usually with collateral vessels† • Subtotally occlusive thrombus on pre-existing plaque • Distal microvascular thromboembolism from plaque-associated thrombus • Thromboembolism from plaque erosion • Non–plaque-associated coronary thromboembolism • Dynamic obstruction (coronary spasm‡ or vascoconstriction) of epicardial and/or microvascular vessels • Progressive mechanical obstruction to coronary flow • <strong>Coronary</strong> arterial inflammation • Secondary UA • <strong>Coronary</strong> artery dissection§ *These causes are not mutually exclusive; some patients have 2 or more causes. †DeWood MA, et al. N Engl J Med 1986;315:417–23. ‡May occur on top of an atherosclerotic plaque, producing missed-etiology angina or UA/NSTEMI. §Rare. Modified with permission from Braunwald E. Circulation 1998;98:2219–22. Anderson JL, et al. J Am Coll Cardiol. 2007;50:e1-e157, Table 3. 16
I IIa IIb III Updated Guidelines Classes of Recommendations Intervention is useful and effective Evidence conflicts/opinions differ but leans towards efficacy Evidence conflicts/opinions differ but leans against efficacy Intervention is not useful/effective and may be harmful
Page 1: Acute Coronary Syndrome: Thoughts o
Page 4 and 5: Case 1 • Exam: • 142/74, HR 88,
Page 6 and 7: Case 1 • Arrival to ED: • ECG
Page 8: Case 1 • Decision made to pursue
Page 12: Evidence Based Data
Page 15: Variables Used in the TIMI Risk Sco
Page 19 and 20: Initial Chest Pain Evaluation Sympt
Page 21 and 22: Variables Used in the TIMI Risk Sco
Page 24 and 25: Lipid Management I IIa IIb III I I
Page 26 and 27: Pravastatin Or atorVastatin Evaluat
Page 28 and 29: Diabetes Mellitus I I I IIa IIb III
Page 30 and 31: Weight Management I IIa IIb III New
Page 32 and 33: Depression I IIa IIb III It is reas
Page 34 and 35: Early Risk Stratification I IIa IIb
Page 36 and 37: Timing of Release of Various Biomar
Page 38 and 39: Immediate Management I IIa IIb III
Page 40 and 41: Anti-Ischemic Therapy I IIa IIb III
Page 42 and 43: Antiplatelet Therapy I IIa IIb III
Page 44 and 45: Initial Conservative Versus Initial
Page 50 and 51: I IIa IIb III Hospital Care Conserv
Page 52 and 53: Risk Factor Modification I IIa IIb
Page 54 and 55: Variables Used in the TIMI Risk Sco

Acute Coronary Syndrome

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