ACS(急性冠症候群)の管理<br>Management of Acute Coronary Syndromes

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ACS(急性冠症候群)の管理
Management of Acute Coronary Syndromes

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  • 製本 Hardcover:ハードカバー版/ページ数 222 p.
  • 言語 ENG
  • 商品コード 9780470725573
  • DDC分類 616.123

Full Description


Acute Coronary Syndrome covers the spectrum of clinical conditions ranging from unstable angina to non-ST elevation myocardial infarction and ST elevation myocardial infarction. These life-threatening disorders are a major cause of emergency medical care, hospitalization and mortality. Management of Acute Coronary Syndromes is designed to provide busy clinicians with a comprehensive guide to the investigation, diagnosis and treatment of these syndromes. It encompasses the latest technologies, including the use of biomarkers and non-invasive imaging procedures. For each condition, the reader is taken through all of the therapeutic options available; in each case the indications and contraindications are evaluated in the light of the latest clinical trials. Potential complications are dealt with in a similar fashion, permitting the reader to anticipate and manage problems as they arise. The authors also present evidence-based recommendations for long-term care of at-risk patients, encompassing pharmacologic therapies and lifestyle management.The book concludes with a comprehensive collection of appendices that include treatment algorithms, risk scores and a summary of the latest management guidelines. Management of Acute Coronary Syndromes is the most up to date and comprehensive evidence-based guide to managing acute coronary syndromes, in a compact and usable format. It will be of interest to busy specialist physicians in cardiovascular medicine, cardiac and vascular surgery, and critical care, as well as primary care physicians and hospitalists who care for patients with these syndromes.

Table of Contents

        List of contributors                       xiii
Foreword xv
Eugene Braunwald
Pathophysiology of acute coronary syndromes 1 (12)
Alisa B. Rosen
Eli V. Gelfand
Introduction 1 (1)
Formation of atherosclerotic plaque 2 (3)
Plaque instability and the development of 5 (2)
ACS
Myocardial ischemia 7 (1)
Thrombus formation 7 (1)
Platelets 7 (2)
Secondary hemostasis 9 (1)
Dynamic obstruction 10 (1)
Progressive mechanical obstruction 10 (1)
Inflammation 11 (1)
Secondary unstable angina 11 (1)
References 11 (2)
Diagnosis of acute coronary syndrome 13 (24)
Eli V. Gelfand
Alisa B. Rosen
Introduction 13 (1)
Definition of myocardial infarction 13 (1)
History 14 (3)
Risk factors 17 (1)
Physical examination 17 (2)
Electrocardiography 19 (7)
The pathophysiologic basis of ST 19 (1)
segment changes during ischemia
Electrocardiography in ST-elevation MI 20 (6)
and identification of the
infarct-related artery
Electrocardiography in unstable angina 26 (1)
and NSTEMI
Cardiac biomarkers 26 (3)
Noninvasive imaging 29 (3)
Echocardiography 29 (1)
Myocardial perfusion imaging 30 (1)
Coronary computed tomography 30 (1)
Cardiovascular magnetic resonance 31 (1)
imaging
Stress testing for diagnosis of ACS 32 (1)
Overall diagnostic pathway for ACS 32 (2)
References 34 (3)
Unstable angina and non-ST-elevation 37 (42)
myocardial infarction
Eli V. Gelfand
Christopher P. Cannon
Introduction 37 (1)
Causes of UA/NSTEMI 37 (1)
Presentation of UA/NSTEMI 38 (1)
General strategies in management of 39 (1)
UA/NSTEMI
Risk stratification of patients with 40 (2)
UA/NSTEMI
Initial management of UA/NSTEMI in the 42 (1)
emergency department
Pharmacologic treatment of ischemia in 43 (3)
UA/NSTEMI
Beta-blockers 44 (1)
Nitrates 44 (1)
Calcium channel blockers 45 (1)
Angiotensin-converting enzyme inhibitors 45 (1)
Morphine 46 (1)
Oxygen 46 (1)
Invasive versus conservative strategy 46 (3)
Antiplatelet therapy in UA/NSTEMI 49 (19)
Aspirin 54 (1)
Clopidogrel 55 (2)
Prasugrel 57 (1)
Glycoprotein llb/llla inhibitors 58 (3)
Anticoagulant therapy in UA/NSTEMI 61 (1)
Unfractionated heparin 61 (1)
Enoxaparin 62 (3)
Direct thrombin inhibitors 65 (1)
Fondaparinux 66 (1)
Oral anticoagulation in UA/NSTEMI 67 (1)
Fibrinolysis in UA/NSTEMI 68 (1)
Early lipid-lowering therapy in patients 68 (1)
with UA/NSTEMI
Predischarge noninvasive risk 69 (2)
stratification after UA/NSTEMI
Overall management of UA/NSTEMI 71 (1)
References 71 (8)
ST-segment-elevation myocardial infarction 79 (44)
Eli V. Gelfand
Christopher P. Cannon
Introduction 79 (1)
Global treatment goals in STEMI 79 (1)
Prehospital management and triage 80 (2)
Transport decisions 82 (1)
Management prior to reperfusion 82 (1)
Primary reperfusion therapy for STEMI 83 (5)
Fibrinolysis 83 (3)
Combination fibrinolysis 86 (1)
Markers of fibrinolysis effectiveness 86 (2)
Complications of fibrinolysis 88 (1)
Primary percutaneous coronary intervention 88 (2)
Comparison of PCI with fibrinolysis 90 (4)
Timing of primary PCI 91 (3)
PCI following fibrinolytic therapy 94 (3)
Rescue PCI 94 (1)
Facilitated PCI 94 (2)
Routine PCI after successful 96 (1)
fibrinolysis
Overall reperfusion strategy 97 (1)
Coronary artery bypass grafting for 98 (1)
treatment of STEMI
Adjunctive pharmacologic treatment of 98 (16)
STEMI
Antiplatelet agents 98 (3)
Anticoagulation therapy 101 (4)
Other adjunctive therapy 105 (5)
Hospital care following successful 110 (4)
reperfusion
References 114 (9)
Special considerations in acute coronary 123 (18)
syndromes
Jason Ryan
Eli V. Gelfand
Secondary unstable angina 123 (1)
Acute coronary syndrome in patients with 123 (4)
diabetes mellitus
General considerations 123 (1)
Primary ACS therapy in diabetics 124 (1)
Glycemic control in diabetics with ACS 125 (1)
Coronary revascularization in diabetics 126 (1)
Metabolic syndrome and ACS 127 (1)
Chronic kidney disease in ACS 127 (3)
Young patients with ACS 130 (1)
ACS in the setting of cocaine use 130 (2)
ACS in patients with normal coronary 132 (1)
arteries or mild CAD
Myocarditis 132 (1)
Acute transient apical ballooning syndrome 133 (1)
Postoperative ACS 134 (1)
ACS in a pregnant woman 135 (1)
Hyperthyroidism and ACS 136 (1)
ACS in patients exposed to radiation 137 (1)
Trauma and ACS 137 (1)
References 137 (4)
Complications of acute coronary syndrome 141 (32)
Jan M. Pattanayak
Eli V. Gelfand
Introduction 141 (1)
Pump failure 141 (7)
General principle 141 (1)
Clinical presentation 142 (2)
Prognosis 144 (1)
Treatment 144 (4)
Right ventricular infarction 148 (4)
Introduction 148 (1)
Clinical presentation 148 (1)
Diagnosis 149 (1)
Management 150 (2)
Prognosis 152 (1)
Mechanical complications of ACS 152 (3)
Introduction 152 (1)
Left ventricular free wall rupture 152 (1)
Ventricular septal rupture 153 (1)
Acute mitral regurgitation 154 (1)
Left ventricular aneurysm 155 (2)
Left ventricular pseudoaneurysm 157 (1)
Pericardial complications 157 (2)
Arrhythmic complications of ACS 159 (5)
Bradyarrhythmias 159 (4)
Atrial fibrillation 163 (1)
Ventricular tachycardia and fibrillation 163 (1)
Complications involving bleeding 164 (1)
Complications of percutaneous coronary 165 (5)
intervention
References 170 (3)
Post-hospitalization care of patients with 173 (36)
acute coronary syndrome
Jersey Chen
Eli V. Gelfand
Introduction 173 (1)
Pharmacologic measures 173 (19)
Aspirin 173 (1)
Clopidogrel 174 (3)
Beta adrenergic blockade 177 (2)
Renin-angiotensin-aldosterone inhibitors 179 (6)
Lipid-lowering therapy 185 (4)
Warfarin 189 (3)
Influenza vaccination 192 (1)
Medications of limited benefit to 192 (3)
patients following ACS
Vitamins/antioxidants 192 (1)
Estrogen replacement therapy 192 (2)
Nonsteroidal anti-inflammatory agents 194 (1)
and related compounds
Nonpharmacologic measures 195 (3)
Antiarrhythmic devices 195 (3)
Therapy of comorbidities following ACS 198 (2)
Diabetes mellitus 198 (1)
Hypertension 199 (1)
Depression 199 (1)
Lifestyle recommendations following ACS 200 (4)
General physical activity and 200 (1)
structured cardiac rehabilitation
Sexual activity after ACS 201 (1)
Smoking cessation 201 (1)
Diet/nutrition and weight loss 202 (2)
References 204 (5)
Appendix 209 (8)
Index 217