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Low Risk Acute Coronary Syndrome ManagementAka: Non-diagnostic Electrocardiogram Protocol, Non-diagnostic EKG Protocol, Atypical Chest Pain
- See Also
- Indications: Immediate MI Management in low risk cases
- ST Depression 0.5 to 1.0 mm
- T Wave inversion or flattening
- Leads with dominant R Wave
- Normal Electrocardiogram
- Contraindications: Moderate Risk patient
- See Moderate Risk Acute Coronary Syndrome Management
- Criteria
- Unstable Angina
- New Onset Angina
- Troponin Increased
- Management: Low Risk
- Aspirin 325 mg PO qd
- Initial Evaluation
- Serum Cardiac Markers
- Repeat Electrocardiogram
- Continuous ST segment monitoring
- Assess Angina Diagnosis likelihood
- Consider Chest Pain differential diagnosis
- Signs of Myocardial Ischemia or Myocardial Infarction
- See Myocardial Ischemia Protocol
- Consider MI Adjunctive Therapy
- Continuous Cardiac Monitoring (follow ST segment)
- Serial Cardiac Markers
- Consider Troponin 6 hours after first Troponin
- Troponin I over 1.0 suggests Acute MI
- Serial Creatine Phosphokinase every 6 hours x3
- Consider Troponin 6 hours after first Troponin
- Imaging studies
- Stress Echocardiogram
- Perfusion Radionuclide scan
- No Signs Myocardial Ischemia or Myocardial Infarction
- Assess adverse event risk (see Unstable Angina Risk)
- Low risk patients do not require telemetry
- Goldman risk score <8% and
- Troponin I <0.3 ng/ml and
- CK-MB <5 ng/ml
- Hollander (2004) Ann Emerg Med 43:71
- Disposition based on Unstable Angina Risk
- High risk for adverse event in near future
- See Myocardial Inschemia Protocol
- Treat same as signs of Myocardial Ischemia above
- Intermediate risk for adverse event in near future
- Continuous Cardiac Monitoring (follow ST segment)
- Troponin 6 hours after first Troponin
- Troponin I over 1.0 suggests Acute MI
- Exercise Stress Test if Troponin negative
- Positive test treated as high risk above
- Negative test treated as low risk below
- Low risk for adverse event in near future
- Discharge from Emergency Department
- Close follow-up with primary physician
- Discuss warning signs
- Outpatient Exercise Stress Testing
- High risk for adverse event in near future
Atypical chest pain (C0262384) | |
|---|---|
| Concepts | Sign or Symptom (T184) |
| English | Atypical chest pain |
| Spanish | dolor de pecho atipico |
| Parent Concepts | Chest Pain (C0008031), Duplicate concept (C1274013) |
| Sources | COSTAR, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
[D]Electrocardiogram (ECG) abnormal (C0522055) | |
|---|---|
| Concepts | Finding (T033) |
| English | Abnormal ECG, Abnormal EKG, Abnormal EKG finding, ABNORMAL ELECTROCARDIOGRAM, ECG ABNORMAL, ELECTROCARDIOGRAM ABNORMAL, electrocardiographic abnormality |
| Spanish | ECG anormal, electrocardiograma anormal, hallazgo anormal en el ECG, hallazgo electrocardiografico anormal |
| Parent Concepts | Conduction disorder of the heart (C0264886), cardiac arrhythmia (C0003811), Cardiac Disorders, General, Functional and NEC (C0549515), EKG finding (C0438154), [D]Unspecified cardiovascular function study abnormal (C0476409), Duplicate concept (C1274013) |
| Sources | AOD, COSTAR, CST, DXP, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
Acute Coronary Syndrome (C0948089) | |
|---|---|
| Definition (MSH) | An episode of MYOCARDIAL ISCHEMIA that generally lasts longer than a transient anginal episode but that does not usually result in MYOCARDIAL INFARCTION. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D054058 |
| English | ACS - Acute coronary syndrome, Acute Coronary Syndrome, Acute Coronary Syndromes |
| Spanish | sindrome coronario agudo |
| Parent Concepts | Myocardial Ischemia (C0151744), Syndrome (C0039082), Cardiomyopathies (C0878544), Acute ischemic heart disease (C1510446), Duplicate concept (C1274013) |
| Sources | MSH, NCI, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
