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Unstable Angina and Non-ST Elevation Myocardial Infarction

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Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) represent part of the acute coronary syndrome (ACS) spectrum that also includes ST elevation myocardial infarction (STEMI). Combined, UA and NSTEMI are known as non-ST elevation acute coronary syndrome (NSTEACS). Recent estimates suggest that 1.4 million hospitalizations occur annually for ACS events in the United States, with 558,000 for UA alone (1). Of those patients with elevated cardiac biomarkers suggestive of myocardial infarction (MI), at least one-half may be classified as NSTEMI (1, 2).

Key Points

• Acute coronary syndromes represent a major public health concern, with 1.4 million hospitalizations occurring annually in the United States; NSTEACS account for 71–83% of these.

• NSTEACS is characterized by anginal chest discomfort accompanied by ischemic electrocardiographic ST-segment abnormalities and/or elevation of cardiac biomarkers.

• The differential diagnosis of NSTEACS includes other life-threatening diagnoses, such as pulmonary embolism, aortic dissection, tension pneumothorax, esophageal rupture, and pericardial tamponade.

• Rupture of a vulnerable atherosclerotic plaque and subsequent thrombus formation are central to the pathophysiology of acute coronary syndromes.

• Risk stratification for recurrent MI, death, or heart failure is central to decision making in NSTEACS.

• The management of NSTEACS includes application of anti-ischemic therapies, antiplatelet therapies, and anticoagulation, as well as selective use of coronary revascularization.

• Secondary prevention includes agents such as aspirin, beta-blockers, lipid-lowering agents, and ACE inhibitors, as well as weight control, smoking cessation, and management of hyperglycemia if present.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Ali Mahajerin MD & Eli V. Gelfand MD

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  1. Ali Mahajerin MD
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  2. Eli V. Gelfand MD
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  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

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Mahajerin, A., Gelfand, E.V. (2011). Unstable Angina and Non-ST Elevation Myocardial Infarction. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_10

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