Management of Acute Coronary Syndromes PDF
Preview Management of Acute Coronary Syndromes
Management of Acute Coronary Syndromes Management of Acute Coronary Syndromes Edited by Eli V. Gelfand and Christopher P. Cannon © 2009 John Wiley & Sons Ltd. ISBN: 978-0-470-72557-3 Management of Acute Coronary Syndromes Eli V. Gelfand DirectorofAmbulatoryCardiology,BethIsrael DeaconessMedicalCenter,HarvardMedicalSchool, Boston,Massachusetts,USA and Christopher P. Cannon SeniorInvestigator,TIMIStudyGroup,Brighamand Women’sHospitalAssociateProfessor,Harvard MedicalSchool,Boston,Massachusetts,USA AJohn Wiley & Sons, Ltd., Publication Thiseditionfirstpublished2009 (cid:2)2009JohnWiley&SonsLtd. Wiley-BlackwellisanimprintofJohnWiley&Sons,formedbythemergerofWiley’sglobalScientific, TechnicalandMedicalbusinesswithBlackwellPublishing. Registeredoffice:JohnWiley&SonsLtd,TheAtrium,SouthernGate,Chichester,WestSussex,PO19 8SQ,UK OtherEditorialOffices: 9600GarsingtonRoad,Oxford,OX42DQ,UK 111RiverStreet,Hoboken,NJ07030-5774,USA Fordetailsofourglobaleditorialoffices,forcustomerservicesandforinformationabouthowto applyforpermissiontoreusethecopyrightmaterialinthisbookpleaseseeourwebsiteat www.wiley.com/wiley-blackwell Therightoftheauthortobeidentifiedastheauthorofthisworkhasbeenassertedinaccordancewith theCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or transmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recordingor otherwise,exceptaspermittedbytheUKCopyright,DesignsandPatentsAct1988,withouttheprior permissionofthepublisher. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprint maynotbeavailableinelectronicbooks. 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LibraryofCongressCataloguing-in-PublicationData Gelfand,EliV. Managementofacutecoronarysyndromes/EliV.GelfandandChristopherP.Cannon. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-0-470-72557-3 1. Coronaryheartdisease. 2. Myocardialinfarction. I. Cannon,ChristopherP. II. Title. [DNLM:1. AcuteCoronarySyndrome—therapy. 2. AcuteDisease—therapy. 3. CoronaryDisease—therapy. WG300G316m2009] RC685.C6G452009 616.1023—dc22 2009001962 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Setin10/12FrutigerbyIntegraSoftwareServicesPvt.Ltd.,Pondicherry,India. PrintedandboundinGreatBritainbyT.J.InternationalLtd,Padstow,Cornwall. FirstImpression 2009 ToEllen,SonyaandLeah,withloveandgratitude. E.G. Contents Listofcontributors xiii Foreword xv EugeneBraunwald Chapter 1 Pathophysiologyofacutecoronarysyndromes 1 AlisaB.RosenandEliV.Gelfand Introduction 1 Formationofatheroscleroticplaque 2 Plaqueinstabilityandthedevelopment ofACS 5 Myocardialischemia 7 Thrombusformation 7 Platelets 7 Secondaryhemostasis 9 Dynamicobstruction 10 Progressivemechanicalobstruction 10 Inflammation 11 Secondaryunstableangina 11 References 11 Chapter 2 Diagnosisofacutecoronarysyndrome 13 EliV.GelfandandAlisaB.Rosen Introduction 13 Definitionofmyocardialinfarction 13 History 14 Riskfactors 17 Physicalexamination 17 Electrocardiography 19 ThepathophysiologicbasisofSTsegment changesduringischemia 19 ElectrocardiographyinST-elevationMIand identificationoftheinfarct-relatedartery 20 Electrocardiographyinunstableanginaand NSTEMI 26 viii Contents Cardiacbiomarkers 26 Noninvasiveimaging 29 Echocardiography 29 Myocardialperfusionimaging 30 Coronarycomputedtomography 30 Cardiovascularmagneticresonanceimaging 31 StresstestingfordiagnosisofACS 32 OveralldiagnosticpathwayforACS 32 References 34 Chapter 3 Unstableanginaandnon-ST-elevation myocardialinfarction 37 EliV.GelfandandChristopherP.Cannon Introduction 37 CausesofUA/NSTEMI 37 PresentationofUA/NSTEMI 38 Generalstrategiesinmanagementof UA/NSTEMI 39 RiskstratificationofpatientswithUA/NSTEMI 40 InitialmanagementofUA/NSTEMIinthe emergencydepartment 42 Pharmacologictreatmentofischemiain UA/NSTEMI 43 Beta-blockers 44 Nitrates 44 Calciumchannelblockers 45 Angiotensin-convertingenzymeinhibitors 45 Morphine 46 Oxygen 46 Invasiveversusconservativestrategy 46 AntiplatelettherapyinUA/NSTEMI 49 Aspirin 54 Clopidogrel 55 Prasugrel 57 GlycoproteinIIb/IIIainhibitors 58 AnticoagulanttherapyinUA/NSTEMI 61 Unfractionatedheparin 61 Enoxaparin 62 Directthrombininhibitors 65 Fondaparinux 66 OralanticoagulationinUA/NSTEMI 67 FibrinolysisinUA/NSTEMI 68 Contents ix Earlylipid-loweringtherapyinpatientswith UA/NSTEMI 68 Predischargenoninvasiveriskstratificationafter UA/NSTEMI 69 OverallmanagementofUA/NSTEMI 71 References 71 Chapter 4 ST-segment-elevationmyocardialinfarction 79 EliV.GelfandandChristopherP.Cannon Introduction 79 GlobaltreatmentgoalsinSTEMI 79 Prehospitalmanagementandtriage 80 Transportdecisions 82 Managementpriortoreperfusion 82 PrimaryreperfusiontherapyforSTEMI 83 Fibrinolysis 83 Combinationfibrinolysis 86 Markersoffibrinolysiseffectiveness 86 Complicationsoffibrinolysis 88 Primarypercutaneouscoronaryintervention 88 ComparisonofPCIwithfibrinolysis 90 TimingofprimaryPCI 91 PCIfollowingfibrinolytictherapy 94 RescuePCI 94 FacilitatedPCI 94 RoutinePCIaftersuccessfulfibrinolysis 96 Overallreperfusionstrategy 97 Coronaryarterybypassgraftingfortreatment ofSTEMI 98 Adjunctivepharmacologictreatment ofSTEMI 98 Antiplateletagents 98 Anticoagulationtherapy 101 Otheradjunctivetherapy 105 Hospitalcarefollowingsuccessful reperfusion 110 References 114 Chapter 5 Specialconsiderationsinacutecoronary syndromes 123 JasonRyanandEliV.Gelfand Secondaryunstableangina 123 x Contents Acutecoronarysyndromeinpatients withdiabetesmellitus 123 Generalconsiderations 123 PrimaryACStherapyindiabetics 124 GlycemiccontrolindiabeticswithACS 125 Coronaryrevascularizationindiabetics 126 MetabolicsyndromeandACS 127 ChronickidneydiseaseinACS 127 YoungpatientswithACS 130 ACSinthesettingofcocaineuse 130 ACSinpatientswithnormalcoronaryarteries ormildCAD 132 Myocarditis 132 Acutetransientapicalballooning syndrome 133 PostoperativeACS 134 ACSinapregnantwoman 135 HyperthyroidismandACS 136 ACSinpatientsexposedtoradiation 137 TraumaandACS 137 References 137 Chapter 6 Complicationsofacutecoronarysyndrome 141 JanM.PattanayakandEliV.Gelfand Introduction 141 Pumpfailure 141 Generalprinciple 141 Clinicalpresentation 142 Prognosis 144 Treatment 144 Rightventricularinfarction 148 Introduction 148 Clinicalpresentation 148 Diagnosis 149 Management 150 Prognosis 152 MechanicalcomplicationsofACS 152 Introduction 152 Leftventricularfreewallrupture 152 Contents xi Ventricularseptalrupture 153 Acutemitralregurgitation 154 Leftventricularaneurysm 155 Leftventricularpseudoaneurysm 157 Pericardialcomplications 157 ArrhythmiccomplicationsofACS 159 Bradyarrhythmias 159 Atrialfibrillation 163 Ventriculartachycardiaandfibrillation 163 Complicationsinvolvingbleeding 164 Complicationsofpercutaneouscoronary intervention 165 References 170 Chapter 7 Post-hospitalizationcareofpatientswithacute coronarysyndrome 173 JerseyChenandEliV.Gelfand Introduction 173 Pharmacologicmeasures 173 Aspirin 173 Clopidogrel 174 Betaadrenergicblockade 177 Renin–angiotensin–aldosterone inhibitors 179 Lipid-loweringtherapy 185 Warfarin 189 Influenzavaccination 192 Medicationsoflimitedbenefittopatients followingACS 192 Vitamins/antioxidants 192 Estrogenreplacementtherapy 192 Nonsteroidalanti-inflammatoryagentsand relatedcompounds 194 Nonpharmacologicmeasures 195 Antiarrhythmicdevices 195 TherapyofcomorbiditiesfollowingACS 198 Diabetesmellitus 198 Hypertension 199 Depression 199 xii Contents LifestylerecommendationsfollowingACS 200 Generalphysicalactivityandstructuredcardiac rehabilitation 200 SexualactivityafterACS 201 Smokingcessation 201 Diet/nutritionandweightloss 202 References 204 Appendix 209 Index 217
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