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'''Unstable angina pectoris''' (NAP) is an '''acute coronary syndrome without ST elevation'''' on [[ECG]].
'''Unstable angina pectoris''' (NAP) is an '''acute coronary syndrome without ST elevation'''' on [[ECG]].


Among '''[[acute coronary syndrome]]y''' (ACS) we include:<ref name="Běl">{{Citation
Among '''[[acute coronary syndrome]]y''' (ACS) we include:<ref name="Běl">{{Cite
| type = article
| type = article
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal= Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712
Line 27: Line 27:


==Etiopathogenesis==
==Etiopathogenesis==
The pathophysiological essence of all ACS is intracoronary [[thrombosis]] superimposed on a superficially damaged (rupture, erosion, fissure), unstable [[atherosclerosis|atherosclerotic plaque]]. In the case of NAP, the resulting obstruction of the coronary artery is incomplete, so myocardial [[Necrosis|necrosis]] does not '''occur'', so the levels of [[Cardiospecific markers|cardiospecific markers]] do not '''increase''.<ref name="ceska">{{Citation
The pathophysiological essence of all ACS is intracoronary [[thrombosis]] superimposed on a superficially damaged (rupture, erosion, fissure), unstable [[atherosclerosis|atherosclerotic plaque]]. In the case of NAP, the resulting obstruction of the coronary artery is incomplete, so myocardial [[Necrosis|necrosis]] does not '''occur'', so the levels of [[Cardiospecific markers|cardiospecific markers]] do not '''increase''.<ref name="ceska">{{Cite
| type = book
| type = book
| isbn = 978-80-7387-423-0
| isbn = 978-80-7387-423-0
| surname1 = Czech
| surname1 = Czech
| name1 = Richard
| name1 = Richard
| collective = yes
| others = yes
| title = Intern
| title = Intern
| issue = 1
| edition = 1
| place = Prague
| location = Prague
| publisher = Triton
| publisher = Triton
| year = 2010
| year = 2010
Line 42: Line 42:
</ref>
</ref>


The causes of NAP include:<ref name="Běl">{{Citation
The causes of NAP include:<ref name="Běl">{{Cite
| type = article
| type = article
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal = Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712
Line 59: Line 59:
</ref><ref>{{Quote
</ref><ref>{{Quote
| type = article
| type = article
| lastname1 = Aschermann
| surname1 = Aschermann
| name1 = Michael
| name1 = Michael
| article = Recommendations for the diagnosis and treatment of unstable angina pectoris - revision 2002
| article = Recommendations for the diagnosis and treatment of unstable angina pectoris - revision 2002
| magazine = Cor et Vasa
| journal = Cor et Vasa
| url = http://www.kardio-cz.cz/index.php?&desktop=clanky&action=view&id=86
| url = http://www.kardio-cz.cz/index.php?&desktop=clanky&action=view&id=86
| year = 2002
| year = 2002
| year = 44
| the_year = 44
| volume = 7-8
| volume = 7-8
| pages = K123–K143
| pages = K123–K143
Line 72: Line 72:
</ref><ref name="gregor">{{Quote
</ref><ref name="gregor">{{Quote
| type = article
| type = article
| lastname1 = Gregor
| surname1 = Gregor
| name1 = P
| name1 = P
| surname2 = Jirmař
| surname2 = Jirmař
| name2 = R
| name2 = R
| article = Unstable angina pectoris
| article = Unstable angina pectoris
| magazine = Cardioforum
| journal = Cardioforum
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| year = 2003
| year = 2003
| year = 2
| the_year = 2
| volume = -
| volume = -
| pages = 13-15
| pages = 13-15
Line 100: Line 100:
:{| class="wikitable"
:{| class="wikitable"
|-
|-
! colspan="2" |Clinical forms of NAP<ref name="Běl">{{Citation
! colspan="2" |Clinical forms of NAP<ref name="Běl">{{Cite
| type = article
| type = article
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal = Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712
Line 129: Line 129:
:{| class="wikitable" align="right"
:{| class="wikitable" align="right"
|-
|-
! colspan="2" |Classification of AP degree according to CCS (Canadian Cardiovascular Society)<ref name="ceska">{{Citation
! colspan="2" |Classification of AP degree according to CCS (Canadian Cardiovascular Society)<ref name="ceska">{{Cite
| type = book
| type = book
| isbn = 978-80-7387-423-0
| isbn = 978-80-7387-423-0
| surname1 = Czech
| surname1 = Czech
| name1 = Richard
| name1 = Richard
| collective = yes
| others = yes
| title = Intern
| title = Intern
| issue = 1
| edition = 1
| place = Prague
| location = Prague
| publisher = Triton
| publisher = Triton
| year = 2010
| year = 2010
Line 146: Line 146:
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal = Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712
Line 176: Line 176:
*'''History:''' risk factors (smoking, [[hyperlipoproteinemia]], [[DM]], [[hypertension]])?, positive family history?, CHD?, previous MI?, exertional AP?, coronary angioplasty?, intracoronary stent?, aortocoronary [[bypass]]? other diseases? permanent medication? allergies?.<ref name="gregor">{{Quote
*'''History:''' risk factors (smoking, [[hyperlipoproteinemia]], [[DM]], [[hypertension]])?, positive family history?, CHD?, previous MI?, exertional AP?, coronary angioplasty?, intracoronary stent?, aortocoronary [[bypass]]? other diseases? permanent medication? allergies?.<ref name="gregor">{{Quote
| type = article
| type = article
| lastname1 = Gregor
| surname1 = Gregor
| name1 = P
| name1 = P
| surname2 = Jirmař
| surname2 = Jirmař
| name2 = R
| name2 = R
| article = Unstable angina pectoris
| article = Unstable angina pectoris
| magazine = Cardioforum
| journal = Cardioforum
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| year = 2003
| year = 2003
| year = 2
| the_year = 2
| volume = -
| volume = -
| pages = 13-15
| pages = 13-15
Line 193: Line 193:
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal = Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712
}}
}}
</ref>
</ref>
*'''Physical examination:''' mostly normal. Tachycardia and increased blood pressure (sympathetic activation) may be present.<ref name="gregor">{{Citation
*'''Physical examination:''' mostly normal. Tachycardia and increased blood pressure (sympathetic activation) may be present.<ref name="gregor">{{Cite
| type = article
| type = article
| lastname1 = Gregor
| surname1 = Gregor
| name1 = P
| name1 = P
| surname2 = Jirmař
| surname2 = Jirmař
| name2 = R
| name2 = R
| article = Unstable angina pectoris
| article = Unstable angina pectoris
| magazine = Cardioforum
| journal = Cardioforum
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| year = 2003
| year = 2003
| year = 2
| the_year = 2
| volume = -
| volume = -
| pages = 13-15
| pages = 13-15
Line 222: Line 222:
</ref>
</ref>
*'''Nitroglycerin test:''' Nitroglycerin is given for chest pain. If the pain subsides within 2 minutes, it is probably angina pectoris. Pain relief after more than 10 minutes is non-specific.<ref>ČEŠKA, Richard, ŠTULC, Tomáš, Vladimír TESAŘ and Milan LUKÁŠ, et al. ''Intern. ''3. edition. Prague: Stanislav Juhaňák - Triton, 2020. 964 pp. 189-200. [[Special:Book Resources/978-80-7553-780-5|ISBN 978-80-7553-780-5]].</ref>
*'''Nitroglycerin test:''' Nitroglycerin is given for chest pain. If the pain subsides within 2 minutes, it is probably angina pectoris. Pain relief after more than 10 minutes is non-specific.<ref>ČEŠKA, Richard, ŠTULC, Tomáš, Vladimír TESAŘ and Milan LUKÁŠ, et al. ''Intern. ''3. edition. Prague: Stanislav Juhaňák - Triton, 2020. 964 pp. 189-200. [[Special:Book Resources/978-80-7553-780-5|ISBN 978-80-7553-780-5]].</ref>
*'''ECG:''' ST segment depression, T wave inversion, new A-V block?, new bundle branch block?. Outside of an anginal attack, the ECG is usually completely normal. If the ECG picture is normal even during an anginal attack, this usually indicates against NAP (possibly against acute ischemia).<ref name="gregor">{{Citation
*'''ECG:''' ST segment depression, T wave inversion, new A-V block?, new bundle branch block?. Outside of an anginal attack, the ECG is usually completely normal. If the ECG picture is normal even during an angina attack, this usually indicates against NAP (possibly against acute ischemia).<ref name="gregor">{{Cite
| type = article
| type = article
| lastname1 = Gregor
| surname1 = Gregor
| name1 = P
| name1 = P
| surname2 = Jirmař
| surname2 = Jirmař
| name2 = R
| name2 = R
| article = Unstable angina pectoris
| article = Unstable angina pectoris
| magazine = Cardioforum
| journal = Cardioforum
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| year = 2003
| year = 2003
| year = 2
| the_year = 2
| volume = -
| volume = -
| pages = 13-15
| pages = 13-15
Line 238: Line 238:
}}
}}
</ref>
</ref>
*'''Biochemical markers of myocardial necrosis:''' are negative in NAP (myocardial necrosis does not occur in NAP).<ref name="gregor">{{Citation
*'''Biochemical markers of myocardial necrosis:''' are negative in NAP (myocardial necrosis does not occur in NAP).<ref name="gregor">{{Cite
| type = article
| type = article
| lastname1 = Gregor
| surname1 = Gregor
| name1 = P
| name1 = P
| surname2 = Jirmař
| surname2 = Jirmař
| name2 = R
| name2 = R
| article = Unstable angina pectoris
| article = Unstable angina pectoris
| magazine = Cardioforum
| journal = Cardioforum
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| year = 2003
| year = 2003
| year = 2
| the_year = 2
| volume = -
| volume = -
| pages = 13-15
| pages = 13-15
| issn = 1801-7606
| issn = 1801-7606
}}
}}
</ref><ref name="ceska">{{Citation
</ref><ref name="ceska">{{Cite
| type = book
| type = book
| isbn = 978-80-7387-423-0
| isbn = 978-80-7387-423-0
| surname1 = Czech
| surname1 = Czech
| name1 = Richard
| name1 = Richard
| collective = yes
| others = yes
| title = Intern
| title = Intern
| issue = 1
| edition = 1
| place = Prague
| location = Prague
| publisher = Triton
| publisher = Triton
| year = 2010
| year = 2010
Line 267: Line 267:
}}
}}
</ref>
</ref>
*'''Selective coronary angiography''': should be performed in all patients with NAP. For hemodynamically stable patients, we perform it early, i.e. within 48–72 hours. We perform it immediately in hemodynamically unstable patients. Diagnostic coronary angiography can be followed by [[PCI]] (percutaneous coronary intervention) or [[CABG]] (coronary artery bypass grafting).<ref name="ceska">{{Citation
*'''Selective coronary angiography''': should be performed in all patients with NAP. For hemodynamically stable patients, we perform it early, i.e. within 48–72 hours. We perform it immediately in hemodynamically unstable patients. Diagnostic coronary angiography can be followed by [[PCI]] (percutaneous coronary intervention) or [[CABG]] (coronary artery bypass grafting).<ref name="ceska">{{Cite
| type = book
| type = book
| isbn = 978-80-7387-423-0
| isbn = 978-80-7387-423-0
| surname1 = Czech
| surname1 = Czech
| name1 = Richard
| name1 = Richard
| collective = yes
| others = yes
| title = Intern
| title = Intern
| issue = 1
| edition = 1
| place = Prague
| location = Prague
| publisher = Triton
| publisher = Triton
| year = 2010
| year = 2010
Line 284: Line 284:
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal = Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712
Line 300: Line 300:
Differential diagnostics should exclude:
Differential diagnostics should exclude:


*other causes of chest pain (STEMI, NSTEMI, ischemia of non-coronary origin, [[aortic dissection]], aortic aneurysm, [[pericarditis]], [[myocarditis]], [[pulmonary embolism]], [[pneumothorax]], [[vertebrogenic algic syndrome]] etc.).<ref>{{Citation
*other causes of chest pain (STEMI, NSTEMI, ischemia of non-coronary origin, [[aortic dissection]], aortic aneurysm, [[pericarditis]], [[myocarditis]], [[pulmonary embolism]], [[pneumothorax]], [[vertebrogenic algic syndrome]] etc.).<ref>{{Cite
| type = book
| type = book
| isbn = 80-7262-106-8
| isbn = 80-7262-106-8
| surname1 = Hradec
| surname1 = Hradec
| name1 = Jaromir
| name1 = Jaromir
| last name2 = He slept
| surname2 = He slept
| name2 = George
| name2 = George
| title = Internal medicine.&nbsp;Volume II,&nbsp;Cardiology, angiology
| title = Internal medicine.&nbsp;Volume II,&nbsp;Cardiology, angiology
| issue = 1
| edition = 1
| place = Prague
| location = Prague
| publisher = Galen :&nbsCaroline
| publisher = Galen :&nbsCaroline
| year = 2001
| year = 2001
Line 315: Line 315:
</ref><ref name="gregor">{{Quote
</ref><ref name="gregor">{{Quote
| type = article
| type = article
| lastname1 = Gregor
| surname1 = Gregor
| name1 = P
| name1 = P
| surname2 = Jirmař
| surname2 = Jirmař
| name2 = R
| name2 = R
| article = Unstable angina pectoris
| article = Unstable angina pectoris
| magazine = Cardioforum
| journal = Cardioforum
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| url = http://www.kardiologickeforum.cz/pdf/kf_03_02_02.pdf\
| year = 2003
| year = 2003
| year = 2
| the_year = 2
| volume = -
| volume = -
| pages = 13-15
| pages = 13-15
Line 335: Line 335:
:{| class="wikitable"
:{| class="wikitable"
|-
|-
! colspan="2" |Initial treatment of a patient with ACS. Taken from <ref name="Běl">{{Citation
! colspan="2" |Initial treatment of a patient with ACS. Taken from <ref name="Běl">{{Cite
| type = article
| type = article
| surname1 = Belohlávek
| surname1 = Belohlávek
| name1 = J
| name1 = J
| lastname2 = Aschermann
| surname2 = Aschermann
| name2 = M
| name2 = M
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| article = Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG
| magazine = Cor et Vasa
| journal = Cor et Vasa
| year = 2008
| year = 2008
| year = 50
| the_year = 50
| volume = Suppl
| volume = Suppl
| sides = 1S7–1S23
| pages = 1S7–1S23
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| url = http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/
| issn = 1803-7712
| issn = 1803-7712

Revision as of 17:22, 13 March 2023

File:AP Atherosclerosis.png Unstable angina pectoris (NAP) is an acute coronary syndrome without ST elevation' on ECG.

Among acute coronary syndromey (ACS) we include:[1]

  1. unstable angina pectoris;
  2. acute myocardial infarction without ST segment elevations (NSTEMI);
  3. acute myocardial infarction with ST segment elevations (STEIMI).

These conditions are an acute manifestation of ischemic heart disease and need to be addressed urgently. A patient with NAP must be hospitalized in a coronary unit.

Etiopathogenesis

The pathophysiological essence of all ACS is intracoronary thrombosis superimposed on a superficially damaged (rupture, erosion, fissure), unstable atherosclerotic plaque. In the case of NAP, the resulting obstruction of the coronary artery is incomplete, so myocardial necrosis does not occur, so the levels of cardiospecific markers do not increase.[2]

The causes of NAP include:[1][3][4]

  • non-occluding thrombosis encroaching on an unstable atherosclerotic plaque;
  • progressing atherosclerotic process;
  • progressive neointimal hyperplasia with the emergence of restenosis;
  • focal epicardial coronary artery spasm (Prinzmetal's AP);
  • inflammation of the coronary artery wall;
  • a number of extracardiac mechanisms (tachycardia, thyrotoxicosis, fever, anemia, hypoxemia, hypotension).

Clinical forms and classification

Clinical forms of NAP[1]
1 quiet AP – manifests at rest, usually lasts longer than 20 minutes
2 newly established AP – at least III. class CCS
3 deteriorated existing AP – at least to III. CCS grade
4 post-infarction AP
Classification of AP degree according to CCS (Canadian Cardiovascular Society)[2][1]
CCS I AP only during heavy exertion, sports activities, fast or long-lasting load
CCS II AP when walking uphill, patient ascends to 1st floor and above without pain/stopping
CCS III AP even when walking on the level, the patient does not go up to the 1st floor without pain/stopping
CCS IV AP while walking around the apartment, resting angina

Clinical symptoms

Patients report "pressure/tightening/burning pain in the chest (angina), the pain can radiate to the neck, lower jaw, upper limbs, back and abdomen. The pain usually subsides within 20 minutes. In addition, anxiety, nausea, vomiting, sweating, dizziness, a feeling of fainting, a feeling of shortness of breathi may be present.

Diagnosis

  • History: risk factors (smoking, hyperlipoproteinemia, DM, hypertension)?, positive family history?, CHD?, previous MI?, exertional AP?, coronary angioplasty?, intracoronary stent?, aortocoronary bypass? other diseases? permanent medication? allergies?.[4][1]
  • Physical examination: mostly normal. Tachycardia and increased blood pressure (sympathetic activation) may be present.[4]
  • Nitroglycerin test: Nitroglycerin is given for chest pain. If the pain subsides within 2 minutes, it is probably angina pectoris. Pain relief after more than 10 minutes is non-specific.[5]
  • ECG: ST segment depression, T wave inversion, new A-V block?, new bundle branch block?. Outside of an anginal attack, the ECG is usually completely normal. If the ECG picture is normal even during an angina attack, this usually indicates against NAP (possibly against acute ischemia).[4]
  • Biochemical markers of myocardial necrosis: are negative in NAP (myocardial necrosis does not occur in NAP).[4][2]
  • Selective coronary angiography: should be performed in all patients with NAP. For hemodynamically stable patients, we perform it early, i.e. within 48–72 hours. We perform it immediately in hemodynamically unstable patients. Diagnostic coronary angiography can be followed by PCI (percutaneous coronary intervention) or CABG (coronary artery bypass grafting).[2][1]

Differential diagnosis

Differential diagnostics should exclude:

Treatment

A patient with NAP must be hospitalized in an intensive care unit with permanent monitoring of vital signs and ECG (preferably in a coronary unit).

introduction of i.v. cannulas recording of a 12-lead ECG
Initial treatment of a patient with ACS. Taken from [1].
continuous monitoring of vital functions and ECG
oxygen delivery 4–8 l/min
blood sampling for the determination of markers of myocardial necrosis
analgosedation (opiates)
ASA 150–300 mg i.v. or p.o.[7]
heparin 5000 j i.v./enoxaparin 1 mg/kg s.c./i.v.
clopidogrel 300–600 mg i.v. (consider IIb/IIIa inhibitors)
metoprolol i.v. according to the clinical condition
  • Antithrombotic treatment: ASA, clopidogrel, IIb/IIIa inhibitors.
  • Anticoagulation treatment: heparin, low molecular weight heparin.
  • Antiischemic treatment: β-blocker (metoprolol), nitrate, calcium channel blocker (amlodipine, felodipine).
  • Hypolipidemic treatment: statin.

Links

Related Articles

External links

References

  1. ↑ Jump up to: a b c d e f g BELOHLÁVEK, J – ASCHERMANN, M. Recommended procedure for diagnosis and treatment of acute coronary syndromes without ST segment elevations on ECG. Cor et Vasa [online]. 2008, y. 50, vol. Suppl, p. 1S7–1S23, Available from <http://www.kardio-cz.cz/resources/upload/data/141_aschermann_supl.pdf/>. ISSN 1803-7712.  Cite error: Invalid <ref> tag; name "Běl" defined multiple times with different content Cite error: Invalid <ref> tag; name "Běl" defined multiple times with different content Cite error: Invalid <ref> tag; name "Běl" defined multiple times with different content Cite error: Invalid <ref> tag; name "Běl" defined multiple times with different content Cite error: Invalid <ref> tag; name "Běl" defined multiple times with different content Cite error: Invalid <ref> tag; name "Běl" defined multiple times with different content
  2. ↑ Jump up to: a b c d CZECH, Richard, et al. Intern. 1. edition. Prague : Triton, 2010. 855 pp. ISBN 978-80-7387-423-0.
  3. ↑
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  4. ↑ Jump up to: a b c d e f
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  5. ↑ ČEŠKA, Richard, ŠTULC, Tomáš, Vladimír TESAŘ and Milan LUKÁŠ, et al. Intern. 3. edition. Prague: Stanislav Juhaňák - Triton, 2020. 964 pp. 189-200. ISBN 978-80-7553-780-5.
  6. ↑ HRADEC, Jaromir – HE SLEPT, George. Internal medicine. Volume II, Cardiology, angiology. 1. edition. Prague : Galen :&nbsCaroline, 2001. ISBN 80-7262-106-8.
  7. ↑ P. Widimsky, et al. Summary of the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Prepared by the Czech Society of Cardiology. Cor et Vasa 58 (2016) e4–e28, as published in the online version of Cor et Vasa at <http://www.sciencedirect.com/science/article/pii/S0010865016000059>
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