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    Medicine: Management of Patients With UA/NSTEMI

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    The document discusses the management of patients with unstable angina/NSTEMI. It defines the conditions and provides details on ECG and cardiac marker testing. It outlines the medical therapies used to stabilize the acute coronary lesion including aspirin, clopidogril, heparin, and GP 2b/3a inhibitors. It also discusses anti-thrombotic therapies and the trials comparing conservative versus invasive therapies for treating UA/NSTEMI patients. Invasive therapy is indicated for patients experiencing ongoing ischemia, ST depression, hemodynamic instability, recent PCI/CABG, positive troponin, evidence of CHF, or malignant arrhythmias.

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    Medicine: Management of Patients With UA/NSTEMI

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    The document discusses the management of patients with unstable angina/NSTEMI. It defines the conditions and provides details on ECG and cardiac marker testing. It outlines the medical therapies used to stabilize the acute coronary lesion including aspirin, clopidogril, heparin, and GP 2b/3a inhibitors. It also discusses anti-thrombotic therapies and the trials comparing conservative versus invasive therapies for treating UA/NSTEMI patients. Invasive therapy is indicated for patients experiencing ongoing ischemia, ST depression, hemodynamic instability, recent PCI/CABG, positive troponin, evidence of CHF, or malignant arrhythmias.

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    The document discusses the management of patients with unstable angina/NSTEMI. It defines the conditions and provides details on ECG and cardiac marker testing. It outlines the medical therapies used to stabilize the acute coronary lesion including aspirin, clopidogril, heparin, and GP 2b/3a inhibitors. It also discusses anti-thrombotic therapies and the trials comparing conservative versus invasive therapies for treating UA/NSTEMI patients. Invasive therapy is indicated for patients experiencing ongoing ischemia, ST depression, hemodynamic instability, recent PCI/CABG, positive troponin, evidence of CHF, or malignant arrhythmias.

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    28 views2 pages

    Medicine: Management of Patients With UA/NSTEMI

    Uploaded by

    api-3829364
    The document discusses the management of patients with unstable angina/NSTEMI. It defines the conditions and provides details on ECG and cardiac marker testing. It outlines the medical therapies used to stabilize the acute coronary lesion including aspirin, clopidogril, heparin, and GP 2b/3a inhibitors. It also discusses anti-thrombotic therapies and the trials comparing conservative versus invasive therapies for treating UA/NSTEMI patients. Invasive therapy is indicated for patients experiencing ongoing ischemia, ST depression, hemodynamic instability, recent PCI/CABG, positive troponin, evidence of CHF, or malignant arrhythmias.

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    Medicine

    Dr.Dara Lec:-3-
    5-Oct-06

    Management of Patients with UA/NSTEMI


    Definition: Angina pectoris with at least one of the following;

    . Occurring at rest or at least on minimal exertion.


    . Occurring with crescendo pattern.
    . Being severe & of new onset.

    ECG & Cardiac markers


    § ST Depression or transient ST elevation or T wave changes occur in at least
    50%.
    § Normal ECG does not exclude diagnosis
    § Elevation of Troponin T or I r used to identify patients with NSTEMI.

    Medical Therapy
    1- Stabilize the acute coronary lesion with ( ASA, Clopidogril, Heparin, GP 2b/3a
    inhibitors ).
    2-Treat residual ischemia ( nitrate,B-blockers, CCB).
    3-Secondary prevention.

    Anti-Thrombotic Therapy

    ASA; 50% reduction in mortality, & continue indefinitely.

    Clopidogril; should be added to ASA for at least 9 months according to CURE &
    CREDO Trials.

    Heparin ; 33% reduction of mortality if added to ASA.


    GP 2b/3a inhibitors; Abciximab, Ebtifibatide, Tirofiban.

    Conservative versus Invasive Therapy

    Trials ; FRISC 2, TACTICS-TIMI 18 & RITA 3.

    Indication for invasive therapy:

    1- ST depression .
    2- Ongoing ischemia.
    3- Hemodynamic unstability.
    4- Post PCI or CABG patients( within 6 months).
    5- positive Troponin.
    6- Evidence of CHF.
    7- Malignant arrhythmias.

    1
    Written By:
    Rand Aras Najeeb

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