Management of Acute Coronary Syndromes

Dr. Eli Gelfand is a clinical cardiologist, who provides comprehensive care for patients with a full range of heart and vascular problems at the Beth Israel Deaconess Medical Center. He is the Director of the Vascular Diagnostic Laboratory, Harvard Medical School and is the, Harvard Medial School and is the Associate Cardiovascular Fellowship Director at Beth Israel Deaconess Medical Center. Dr. Christopher P. Cannon, is an Associate Professor of Medicine at Harvard Medical School and an Associate Physician in the Cardiovascular Division at Brigham and Women's Hospital in Boston, Massachusetts. He is a senior investigator of the Thrombolysis in Myocardial Infarction (TIMI) Study Group. Dr. Cannon has published more than 500 original articles, reviews, editorials, book chapters, and electronic publications in the field of acute coronary syndromes. Dr. Cannon has received numerous awards including the Alfred Steiner Research Award, Upjohn Achievement in Research Award, and Robert F. Loeb Award for Excellence in Clinical Medicine. He is a Fellow of the American Heart Association and of the American College of Cardiology.

List of contributors. Foreword (Eugene Braunwald). Chapter 1 Pathophysiology of acute coronary syndromes (Alisa B. Rosen and Eli V. Gelfand). Introduction. Formation of atherosclerotic plaque. Plaque instability and the development of ACS. Myocardial ischemia. Thrombus formation. Platelets. Secondary hemostasis. Dynamic obstruction. Progressive mechanical obstruction. Inflammation. Secondary unstable angina. References. Chapter 2 Diagnosis of acute coronary syndrome (Eli V. Gelfand and Alisa B. Rosen). Introduction. Definition of myocardial infarction. History. Risk factors. Physical examination. Electrocardiography. The pathophysiologic basis of ST segment changes during ischemia. Electrocardiography in ST-elevation MI and identification of the infarct-related artery. Electrocardiography in unstable angina and Cardiac biomarkers. Noninvasive imaging. Echocardiography. Myocardial perfusion imaging. Coronary computed tomography. Cardiovascular magnetic resonance imaging. Stress testing for diagnosis of ACS. Overall diagnostic pathway for ACS. References. Chapter 3 Unstable angina and non-ST-elevation myocardial infarction(Eli V. Gelfand and Christopher P. Cannon). Introduction. Causes of UA/NSTEMI. Presentation of UA/NSTEMI. General strategies in management of UA/NSTEMI. Risk stratification of patients with UA/NSTEMI. Initial management of UA/NSTEMI in the emergency department. Pharmacologic treatment of ischemia in UA/NSTEMI. Beta-blockers. Nitrates. Calcium channel blockers. Angiotensin-converting enzyme inhibitors. Morphine. Oxygen. Invasive versus conservative strategy. Antiplatelet therapy in UA/NSTEMI. Aspirin. Clopidogrel. Prasugrel. Glycoprotein IIb/IIIa inhibitors. Anticoagulant therapy in UA/NSTEMI. Unfractionated heparin. Enoxaparin. Direct thrombin inhibitors. Fondaparinux. Oral anticoagulation in UA/NSTEMI. Fibrinolysis in UA/NSTEMI. Early lipid-lowering therapy in patients with UA/NSTEMI. Predischarge noninvasive risk stratification after UA/NSTEMI. Overall management of UA/NSTEMI. References. Chapter 4 ST-segment-elevation myocardial infarction (Eli V. Gelfand and Christopher P. Cannon). Introduction. Global treatment goals in STEMI. Prehospital management and triage. Transport decisions. Management prior to reperfusion. Primary reperfusion therapy for STEMI. Fibrinolysis. Combination fibrinolysis. Markers of fibrinolysis effectiveness. Complications of fibrinolysis. Primary percutaneous coronary intervention. Comparison of PCI with fibrinolysis. Timing of primary PCI. PCI following fibrinolytic therapy. Rescue PCI. Facilitated PCI. Routine PCI after successful fibrinolysis. Overall reperfusion strategy. Coronary artery bypass grafting for treatment of STEMI. Adjunctive pharmacologic treatment of STEMI. Antiplatelet agents. Anticoagulation therapy. Other adjunctive therapy. Hospital care following successful reperfusion. References. Chapter 5 Special considerations in acute coronary syndromes (Jason Ryan and Eli V. Gelfand). Secondary unstable angina. Acute coronary syndrome in patients with diabetes mellitus. General considerations. Primary ACS therapy in diabetics. Glycemic control in diabetics with ACS. Coronary revascularization in diabetics. Metabolic syndrome and ACS. Chronic kidney disease in ACS. Young patients with ACS. ACS in the setting of cocaine use. ACS in patients with normal coronary arteries or mild CAD. Myocarditis. Acute transient apical ballooning syndrome. Postoperative ACS. ACS in a pregnant woman. Hyperthyroidism and ACS. ACS in patients exposed to radiation. Trauma and ACS. References. Chapter 6 Complications of acute coronary syndrome (Jan M. Pattanayak and Eli V. Gelfand). Introduction. Pump failure. General principle. Clinical presentation. Prognosis. Treatment. Right ventricular infarction. Introduction. Clinical presentation. Diagnosis. Management. Prognosis. Mechanical complications of ACS. Introduction. Left ventricular free wall rupture. Ventricular septal rupture. Acute mitral regurgitation. Left ventricular aneurysm. Left ventricular pseudoaneurysm. Pericardial complications. Arrhythmic complications of ACS. Bradyarrhythmias. Atrial fibrillation. Ventricular tachycardia and fibrillation. Complications involving bleeding. Complications of percutaneous coronary intervention. References. Chapter 7 Post-hospitalization care of patients with acute coronary syndrome (Jersey Chen and Eli V. Gelfand). Introduction. Pharmacologic measures. Aspirin. Clopidogrel. Beta adrenergic blockade. Renin-angiotensin-aldosterone inhibitors. Lipid-lowering therapy. Warfarin. Influenza vaccination. Medications of limited benefit to patients following ACS. Vitamins/antioxidants. Estrogen replacement therapy. Nonsteroidal anti-inflammatory agents and related compounds. Nonpharmacologic measures. Antiarrhythmic devices. Therapy of comorbidities following ACS. Diabetes mellitus. Hypertension. Depression. Lifestyle recommendations following ACS. General physical activity and structured cardiac rehabilitation. Sexual activity after ACS. Smoking cessation. Diet/nutrition and weight loss. References. Appendix. Index.