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chest pain (stable angina (identify other possible causes
of chest pain,,…
chest pain
stable angina
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identify other possible causes
of chest pain,
non-atheromatous disease of the coronary arties , such as anomalous coronary arteries, coronary dissection , or coronary compression from other structure
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pulmonary pathology (infection, mass/
nodule, or pneumothorax
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Stable angina is a chronic medical condition associated with a low but appreciable incidence of acute coronary events and increased mortality. The aim of management is to improve quality of life by stopping or minimising symptoms and reducing long-term morbidity and mortality.
Although BB can reduce mortality and morbidity in patients with heart failure with reduced ejection fraction and in patients with recent MI, :<3:
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A combination of BB and non-DHP CCB should be avoided due to the risk of symptomatic bradycardia and atrioventricular block. :red_cross:
drug thearpy
Nicorandil, which is a nitrate-moiety nicotinamide ester and adenosine-sensitive potassium channel opener, increases coronary blood flow and prevents coronary artery spasm.
ACS
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Diagnostic Procedures
history, physical examination, ECG, and serum biomarkers
All patients with symptoms suggestive of acute coronary syndromes should have a 12-lead ECG performed within 10 minutes of presentation
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Draw blood from all patients at presentation with symptoms suggestive of acute coronary syndromes to measure cardiac biomarkers
Cardiac-specific troponin levels (T or I) are highly sensitive and specific; they are the preferred diagnostic biomarker for initial testing
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Physical examination
Blood pressure may be within reference range, elevated (owing to pain), or low (owing to cardiogenic shock)
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definition
Acute coronary syndromes are several potentially lifethreatening conditions associated with acute myocardial ischemia and/or infarction that most commonly result from a sudden decrease in coronary blood flow precipitated by acute thrombosis secondary to a rupture or eroded atherosclerotic coronary plaque
Syndromes include ST-elevation myocardial infarction, non–ST-elevation myocardial infarction, and unstable angina
Drug therapy
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Antiplatelet drugs
aspirin
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Aspirin Oral tablet; Adults: 160 mg to 325 mg PO non-enteric coated tablet, chewed and swallowed immediately, regardless of concomitant fibrinolytic therapy. Maintenance: 75 mg to 162 mg PO once daily.
plavix
Reduce platelet aggregation by blocking the P2Y₁₂ adenosine diphosphate receptor on platelets, which reduces thrombus formation, increases bleeding time, and reduces blood viscosity
For patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention, prasugrel or ticagrelor are preferred over clopidogrel; cangrelor may be an option for patients who are unable to take an oral P2Y₁₂ inhibitor
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Statins
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Initiate (or continue) high-intensity statin therapy in all patients who do not have contraindications
Atorvastatin Calcium Oral tablet; Adults: Dosage not established. 10 to 40 mg PO daily for 6 to 12 months has been studied. Clinical practice guidelines recommend statins only in patients with a recent or remote history of MI or ACS.
ACEI:
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Lisinopril Oral tablet; Adults who are hemodynamically stable: Begin within 24 hours of symptom onset. Administer one 5 mg PO dose, followed by 5 mg PO after 24 hours, 10 mg PO after 48 hours, and then 10 mg PO once daily. If no complications or LV dysfunction by 6 weeks after AMI, ACEI can be stopped
management
Smoking cessation
Advise all patients to avoid exposure to tobacco smoke; tobacco users should be advised to quit at each contact
Blood pressure
In patients with increased cardiovascular risk (including stable ischemic heart disease), reduction of systolic blood pressure to less than 130/80 mm Hg has been shown to reduce cardiovascular disease complications by 25% and all-cause mortality by 27%
Lipid management
Reduce LDL-C by at least 50% with high-intensity statin therapy or maximally tolerated statin therapy
In very high–risk atherosclerotic cardiovascular disease, use an LDL-C threshold of 70 mg/dL to consider addition of nonstatins to statin therapy
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what's problem?
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Vital signs:T:36.8℃, P:94 bpm, R:18 bpm, BP:172/102 mmHg
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