January 2014 (Volume 2, Number 1)
This issue includes 4 AMA PRA Category 1 CreditsTM; and 4 AOA Cetegory 2A or 2B CME credits
Ambarish Gopal, MD, FACC, FSCCT
Consultant, The Heart Group; Medical Director, Cardiovascular CT & Transcatheter Heart Valve Program, Heart Hospital Baylor Plano, Baylor Scott and White Healthcare System, Plano, TX
David M. Shavelle, MD, FACC, FSCAI
Associate Professor of Clinical Medicine, Director, Cardiac Catheterization Laboratories, Director, Interventional Cardiology Fellowship, LAC+USC Medical Center; Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA
Deepak L. Bhatt, MD, MPH, FACC, FAHA, FSCAI, FESC
Professor of Medicine, Harvard Medical School; Chief of Cardiology, VA Boston Healthcare System; Director, Integrated Interventional Cardiovascular Program, Brigham and Women's Hospital & VA Boston Healthcare System, Boston, MA; Senior Investigator, TIMI Study Group
Tomas Villaneuva, DO, MBA, FACPE, SFHM
Assistant Vice President, Medical Director of Primary Care and Hospital Medicine, Baptist Health Medical Group, Baptist Health South Florida, Coral Gables, FL
Coronary artery disease is the leading cause of death in the United States, and up to 30% of patients who suffer a cardiac event will die within a year of diagnosis. “Acute coronary syndromes" (ACS) is a general term that describes a spectrum of conditions related to the acute manifestations of coronary disease, and it includes 3 conditions: (1) unstable angina, (2) ST-segment elevation myocardial infarction (STEMI), and (3) non-ST-segment elevation myocardial infarction (NSTEMI). Incorporating evidence-based strategies in evaluation and risk stratification and determining treatment strategies that are appropriate to the diagnosis are vital to successful management of patients with acute coronary syndromes. This issue reviews the evidence for the numerous therapies for acute coronary syndromes, including drug therapies and revascularization strategies. Inhospital complications, quality improvement, and risk management considerations for acute coronary syndromes are also reviewed.
Excerpt From This Issue
Case 1: It is 4AM on a Friday. A nurse calls you, the on-call hospitalist, regarding a 56-year-old white male with chest pain. The patient is currently admitted with pneumonia. He is having chest pressure, which awoke him from sleep approximately 20 minutes ago. The chest pressure has been constant, with associated nausea and diaphoresis. The patient’s risk factors include hypertension and a family history of premature coronary artery disease in 2 first-degree relatives. You immediately go in to evaluate the patient and request a STAT ECG. As you enter the room, you contemplate what your next steps will be if the ECG shows ST elevation….should you take this patient to the cath lab?