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acute%20coronary%20syndromes%20w_out%20persistent%20st-segment%20elevation

ACUTE CORONARY SYNDROMES W/OUT 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.
NSTEMI 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.

Acute%20coronary%20syndromes%20w_out%20persistent%20st-segment%20elevation Management

Management

Monitoring

Further Testing

May be performed prior to discharge or as an outpatient
Stress test to provoke ischemia
- Consider evaluation of left ventricular function if ischemia is present
- If stress test is negative and history is still suggestive of ischemic pain, may consider nuclear scan, cardiac MRI or diagnostic coronary angiogram
- If stress test is negative and history is not suggestive of ischemic pain, alternative diagnosis should be sought
Treadmill ECG, stress myocardial perfusion imaging, or stress echocardiography before discharge or within 72 hours after discharge is suggested in patients with possible ACS who have normal serial ECGs and cardiac troponins
Treat patient appropriately

Dapagliflozin DELIVERs across full HF spectrum regardless of LVEF

Elvira Manzano, 04 Oct 2022

The selective, oral sodium–glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin reduces the risk of cardiovascular (CV) death or worsening heart failure (HF) in patients with HF and mildly reduced or preserved ejection fraction (HFmrEF or HFpEF) in the phase III DELIVER* trial, touted as the largest and most inclusive thus far in this patient group.

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Empagliflozin not just another SGLT2i: Cardio-renal benefits extend to HF with or without diabetes

Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.