What is NSTE ACS?

Non-ST elevation-acute coronary syndrome (NSTE-ACS) includes NSTE myocardial infarction and unstable angina. This patient population forms approximately two-thirds of all hospital admissions for ACS in the United States each year and is associated with an in-hospital mortality of 5%.

What is the preferred cardiac biomarker for ACS?

The cardiac troponins, in particular, have become the cardiac markers of choice for patients with ACS, eclipsing CK-MB and myoglobin in terms of clinical value.

What should be included in a reperfusion strategy?

Selecting the optimal reperfusion strategy requires customization based on patient factors including time from symptom onset to first medical contact (FMC), the amount of myocardium at risk, the presence of shock or severe heart failure, the risk of bleeding with fibrinolysis, and the time required to perform PCI ( …

What is a goal of guideline directed treatment for ACS?

Continuing guideline-directed medical therapy after STEMI and PCI aims at preventing recurrences of ischemic cardiac events and improving morbidity and mortality of the patients discharged with a diagnosis of ACS.

Is NSTE-ACS the same as NSTEMI?

For the sake of clarity: NSTE-ACS is defined as an acute coronary syndrome without ST elevations on ECG. The majority of patients with NSTE-ACS will exhibit elevated troponins, which is evidence for myocardial infarction and therefore defines the condition as NSTEMI (Non ST Elevation Myocardial Infarction).

What findings on ECG suggest non ST-segment elevation ACS NSTE-ACS?

The ECG in NSTE-ACS may show ST-segment depression, T-wave flattening or inversion, or even transient ST-segment elevation; variation with symptoms favors an ACS diagnosis. Biomarkers such as cardiac troponins are crucial in recognizing myocardial injury and differentiating NSTEMI from unstable angina.

How do you rule out ACS?


  1. Electrocardiogram (ECG). Electrodes attached to your skin measure the electrical activity in your heart.
  2. Blood tests. Certain enzymes may be detected in the blood if cell death has resulted in damage to heart tissue.

What is reperfusion therapy and guidelines?

Reperfusion therapy is defined as the first reperfusion therapy used to restore blood flow through a suspected or known occluded coronary artery immediately on diagnosis and includes intravenous thrombolysis, primary angioplasty, intracoronary thrombolysis, or immediate coronary artery bypass grafting surgery.

What is PCI in reperfusion therapy?

Reperfusion therapy includes drugs and surgery. The drugs are thrombolytics and fibrinolytics used in a process called thrombolysis. Surgeries performed may be minimally-invasive endovascular procedures such as a percutaneous coronary intervention (PCI), which involves coronary angioplasty.

What is the ACS protocol?

The most frequently used regimen is IV metoprolol 2-5 mg given every 5 minutes (up to 15 mg total) followed by 25-100 mg given orally twice a day. Beta-blockers should not be used acutely in patients with cardiogenic shock or signs of heart failure on presentation.

Which conditions are contraindications to therapy with β blockers in patients with ACS?

Contraindications for β-blockers administration are: hypotension (systolic blood pressure < 100 mmHg), bradycardia (heart rate < 50 bpm), phenomenon Raynaud, severe pneumonopathy (especially chronic obstructive and bronchial asthma), and severe renal insufficiency.

What are the guidelines for cervical cancer screening?

The American Cancer Society recommends that women follow these guidelines to help find cervical cancer early. Following these guidelines can also find pre-cancers, which can be treated to keep cervical cancer from starting. All women should begin cervical cancer testing (screening) at age 21.

What are the ESC guidelines?

Disclaimer: The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.

Should I continue cervical cancer screening after a hysterectomy?

People who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above. People who have been vaccinated against HPV should still follow these guidelines for their age groups.

When should patients with nste-1 very-high-risk criteria undergo an immediate invasive strategy ACS?

It is recommended that patients at very high risk (i.e. with at least The TRILOGY ACS trial randomized 7243 patients with NSTE- one very-high-risk criterion) undergo an immediate invasive strategy ACS ,75 years of age selected for medical management to clopido- (,2 h).