Non-ST-elevation myocardial infarction - Revision history

Danbot: Add MedicationDose entries (aspirin, enoxaparin, heparin, nitroglycerin) with SMW annotations

2026-03-20T18:31:04Z

Add MedicationDose entries (aspirin, enoxaparin, heparin, nitroglycerin) with SMW annotations

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 ====Summary of Class III Guidelines====
 *In UA/NSTEMI patients with a prior history of stroke or TIA for whom PCI is planned, prasugrel is potentially harmful as part of a dual-antiplatelet therapy regimen.([[EBQ:Evidence Levels|Level B]])
 ==Disposition==

2021-03-11T15:55:25Z

← Revisión anterior		Revisión del 15:55 11 mar 2021
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	*NSTEMI includes Type 2 -Type 5 biomarker elevations		*NSTEMI includes Type 2 -Type 5 biomarker elevations

	~~===~~Types ~~of Myocardial Infarction===~~		{{MI Types by Causation}}
	~~:'''Type 1:''' Ischemic myocardial necrosis due to plaque rupture (ACS)~~
	~~:'''Type 2:''' Ischemic myocardial necrosis due to supply-demand mismatch, e.g. coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias.~~
	~~:'''Type 3:''' Sudden cardiac death (no cTr values)~~
	~~:'''Type 4:''' Procedure related, post PCI or stent thrombosis ( cTr > 5X Decision Level).~~
	~~:'''Type 5:''' Post CABG (cTr > 10X Decision Level).~~

	==Clinical Features==		==Clinical Features==

2021-03-11T15:49:34Z

← Revisión anterior		Revisión del 15:49 11 mar 2021
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	==Background==		==Background==
			*Also known as NSTEMI
	*33% with confirmed MI have no chest pain on presentation (especially older, female, [[DM]], [[CHF]])		*33% with confirmed MI have no chest pain on presentation (especially older, female, [[DM]], [[CHF]])
	*5% of NSTEMI will develop [[Cardiogenic Shock]] (60% mortality)		*5% of NSTEMI will develop [[Cardiogenic Shock]] (60% mortality)

2021-03-11T15:49:13Z

← Revisión anterior	Revisión del 15:49 11 mar 2021
(Sin diferencias)

2021-03-06T02:51:42Z

Antiplatelets

← Revisión anterior		Revisión del 02:51 6 mar 2021
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	*Medical management vs cath determined by level of risk for future cardiovascular events		*Medical management vs cath determined by level of risk for future cardiovascular events

	===Antiplatelets===		===[[Antiplatelets]]===
	*[[Aspirin]]		*[[Aspirin]]
	**Recommended dose is 325 mg chewed		**Recommended dose is 325 mg chewed

2019-09-24T04:12:35Z

Other

← Revisión anterior		Revisión del 04:12 24 sep 2019
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	**Use cautiously in inferior MI or if on sildenafil		**Use cautiously in inferior MI or if on sildenafil
	**Not shown to decrease MACE		**Not shown to decrease MACE
	*Analgesia		*[[Analgesia]]
	**[[Morphine]], [[Fentanyl]], or other opioid (AHA ACA Level IIb)		**[[Morphine]], [[Fentanyl]], or other opioid (AHA ACA Level IIb)
	**Do not use NSAIDs other than ASA (AHA ACA Level III: Harm)		**Do not use NSAIDs other than ASA (AHA ACA Level III: Harm)
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	*[[Transfusion]]		*[[Transfusion]]
	**Transfuse to keep hemoglobin >10		**Transfuse to keep hemoglobin >10
	*Thrombolytics		*[[Thrombolytics]]
	**''Not indicated'' (only useful for [[STEMI]])		**''Not indicated'' (only useful for [[STEMI]])

2019-09-19T17:56:21Z

Management

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 ===Antithrombotics===
-*Give heparin or enoxaparin along with ASA (Class 1A evidence)
+*Give [[heparin]] or [[enoxaparin]] along with ASA (Class 1A evidence)
 *[[Enoxaparin]] (Lovenox)
 **1mg/kg subq BID
@@ Línea 64: / Línea 64: @@
 **Bolus 60-70u/kg (max 5000) followed by infusion of 12-15u/kg/hr (max 1000/hr), goal ptt 45-75s
 **Consider if patient likely to undergo PCI/CABG within 24hr of admission or in setting of renal failure
-*Hirudin
+*[[Hirudins]]
 **Approved only for patients with [[HIT]]
@@ Línea 92: / Línea 92: @@
 *Thrombolytics
 **''Not indicated'' (only useful for [[STEMI]])
 ==Disposition==

2019-03-30T15:24:53Z

Text replacement - " NTG " to " nitroglycerin "

← Revisión anterior		Revisión del 15:24 30 mar 2019
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	**Use only if SpO2 <90%		**Use only if SpO2 <90%
	*[[Nitroglycerin\|Nitrates]] (decrease preload)		*[[Nitroglycerin\|Nitrates]] (decrease preload)
	**Administer sublingual ~~NTG~~ every 5 min x3 for continuing ischemic pain and then assess need for IV ~~NTG~~ (AHA ACA Level I)		**Administer sublingual [[nitroglycerin]] every 5 min x3 for continuing ischemic pain and then assess need for IV [[nitroglycerin]] (AHA ACA Level I)
	**Use cautiously in inferior MI or if on sildenafil		**Use cautiously in inferior MI or if on sildenafil
	**Not shown to decrease MACE		**Not shown to decrease MACE

2018-09-21T01:53:26Z

Antiplatelet

← Revisión anterior		Revisión del 01:53 21 sep 2018
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	*Medical management vs cath determined by level of risk for future cardiovascular events		*Medical management vs cath determined by level of risk for future cardiovascular events

	===~~Antiplatelet~~===		===Antiplatelets===
	*[[Aspirin]]		*[[Aspirin]]
	**Recommended dose is ~~325mg~~ chewed		**Recommended dose is 325 mg chewed
	**Reduces death from MI by 12.5 → 6.4%		**Reduces death from MI by 12.5 → 6.4%
	**Should be used in all ACS unless contraindicated (eg [[Anaphylaxis]])		**Should be used in all ACS unless contraindicated (eg [[Anaphylaxis]])
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	*[[Clopidogrel]] (see drug link for specific age and indication-related dosages)		*[[Clopidogrel]] (see drug link for specific age and indication-related dosages)
	**Give in addition to ASA		**Give in addition to ASA
	**Mortality benefit with NSTEMI (CURE trial: Decrease in cardiovascular death, MI or stroke by 9.3-11.5%)		**Mortality benefit with NSTEMI (CURE trial: Decrease in cardiovascular death, MI, or stroke by 9.3-11.5%)
	**Main risk and contraindication is bleeding		**Main risk and contraindication is bleeding
	*GPIIb/IIIa Inhibitors		*GPIIb/IIIa Inhibitors

2018-09-21T01:49:54Z

Types of Myocardial Infarction

← Revisión anterior		Revisión del 01:49 21 sep 2018
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	===Types of Myocardial Infarction===		===Types of Myocardial Infarction===
	:'''Type 1:''' Ischemic myocardial necrosis due to plaque rupture ( ACS)		:'''Type 1:''' Ischemic myocardial necrosis due to plaque rupture (ACS)
	:'''Type 2:''' Ischemic myocardial necrosis due to supply-demand mismatch, e.g. coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias.		:'''Type 2:''' Ischemic myocardial necrosis due to supply-demand mismatch, e.g. coronary spasm, embolism, low or high blood pressures, anemia, or arrhythmias.
	:'''Type 3:''' ~~sudden~~ cardiac death (no cTr values)		:'''Type 3:''' Sudden cardiac death (no cTr values)
	:'''Type 4:''' ~~procedure~~ related, post PCI or stent thrombosis ( cTr > 5X Decision Level).		:'''Type 4:''' Procedure related, post PCI or stent thrombosis ( cTr > 5X Decision Level).
	:'''Type 5:''' ~~post~~ CABG (cTr > 10X Decision Level).		:'''Type 5:''' Post CABG (cTr > 10X Decision Level).

	==Clinical Features==		==Clinical Features==