acute%20coronary%20syndromes%20w_o%20persistent%20st-segment%20elevation
ACUTE CORONARY SYNDROMES W/O PERSISTENT ST-SEGMENT ELEVATION
Acute coronary syndromes refer to any constellation of clinical symptoms compatible with acute myocardial ischemia which may be life-threatening.
It encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
Unstable angina is the ischemic discomfort that presents without persistent ST-segment elevation on ECG and without the presence of cardiac markers in the blood.
Non-ST-segment elevation myocardial infarction is diagnosed if cardiac markers are positive with ST-segment depression or with nonspecific or normal ECGs.
The patient typically presents with ischemic-type chest pain that is severe and prolonged and may occur at rest or may be caused by less exertion than previous episodes.

Supportive Therapy

Bed Rest

  • Usually prescribed initially in patients with UA/NSTEMI while ischemia is ongoing
    • Patient can be mobilized to bedside commode or chair when symptom-free
  • Ambulation as tolerated may begin once patient has been hemodynamically stable without recurrent symptoms for 12-24 hours
    • Subsequent activity should not be inappropriately restricted
    • Focus should be on the prevention of recurrent symptoms and activity may be increased once patient responds to therapy

Supplemental O2

  • Give supplemental O2 to all patients with overt pulmonary congestion or arterial O2 saturation <90% or respiratory distress or other high-risk features of hypoxemia
  • Consider in all patients with ACS for the 1st 6 hours of therapy
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
28 Dec 2017
Varenicline, while effective for smoking cessation, appears to significantly elevate the risk of cardiovascular hospitalization and emergency department visits, particularly for new users, a recent study shows.
26 Jan 2018
In children, a short duration of sleep appears to be a significant risk factor for elevated cardiometabolic risk, suggesting that parents need to be mindful of their children’s sleep hygiene, a recent Spanish study has shown.
21 Dec 2017
Physicians’ practice patterns in managing hypertension, and their awareness of blood pressure variability, were reported in a recent study in Singapore. We discussed some of the clinical practice gaps identified by this study with author, A/Prof. Teo Boon Wee.
21 Dec 2017
Results from the ASCOT-LLA study suggest that patient reports of muscle-related adverse events were more common when patients knew they were being treated with a statin. We discussed this phenomenon, known as the ‘nocebo effect’, with senior investigator, Prof. Peter Sever.