Unstable Angina

This clinical practice guideline was developed by a 19-member panel that included physicians, cardiovascular nurse specialists, a public health representative, & a consumer representative. Their recommendations outline a comprehensive care plan for patients with unstable angina, further refined by peer & pilot review. The guideline is written to be directly applicable to patient care & is intended for use by a broad range of health care practitioners, including cardiologists, cardiac surgeons, family practitioners, internists, & nurses. Charts, graphs, tables & glossary. Also includes a 20-page Patient & Family Guide, Managing Unstable Angina.Ó

A critical phase in coronary heart disease, unstable angina, is thoroughly discussed in contributions by well-known experts. Since myocardial infarction still belongs to the main causes of death, this topic is highly relevant for the present research and possible future treatment of coronary heart disease. The major recent advances made in the pathophysiology, diagnosis and therapy of unstable angina are reported in depth.

The electrocardiogram (ECG) remains the most accessible and inexpensive diagnostic tool to evaluate the patient presenting with symptoms suggestive of acute myocardial ischemia. It plays a crucial role in decision making about the aggressiveness of therapy especially in relation to reperfusion therapy, because such therapy has resulted in a considerable reduction in mortality from acute myocardial infarction. Several factors play a role in the amount of myocardial tissue that can be salvaged by reperfusion therapy, such as the time interval between onset of coronary occlusion and reperfusion, site and size of the jeopardized area, type of reperfusion attempt (thrombolytic agent or an intracoronary catheter intervention), presence or absence of risk factors for thrombolytic agents, etc. Most important in decision making on reperfusion therapy and the type of intervention is to look for markers indicating a higher mortality rate from myocardial infarction. The ECG is a reliable, inexpensive, non-invasive instrument to obtain that information. Recently it has become clear that both in anterior and inferior myocardial infarction, the ECG frequently allows not only to identify the infarct related coronary artery, but also the site of occlusion in that artery and therefore the size of the jeopardized area. Obviously, the more proximal the occlusion, the larger the area at risk and the more aggressive the reperfusion attempt.

The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. In this report, the IOM makes several recommendations for improving SSA's capacity to determine disability benefits more quickly and efficiently using the Listings.

Nursing the Cardiac Patient is a practical guide that addresses the management of cardiac patients across the spectrum of health care settings. It assists nurses in developing a complete understanding of the current evidence-based practice and principles underlying the care and management of the cardiac patient. It combines theoretical and practical components of cardiac care in an accessible and user-friendly format, with case studies and practical examples throughout.

No detailed description available for "Nitroglycerin 6".

Unstable angina (UA) comprises a broad spectrum of ischemic heart disease & is associated with varying levels of risk for unfavorable outcomes including myocardial infarction & death. This report is based on 3 systematic reviews of published studies through 1998. The first review concerned the value of the electrocardiogram, physical exam., & clinical history in predicting outcomes for patients with UA. The second review examined the ability of troponin to predict outcomes in patients with proven or suspected UA. The third review examined the efficacy of chest pain units & emergency department protocols in patients who have suspected UA or myocardial infarction. Charts & tables.