Non-ST segment elevation acute coronary syndromes: A comprehensive review

As the non-ST segment elevation acute coronary syndromes (NSTEACS) include unstable angina pectoris (UAP) and the non-ST segment elevation myocardial infarction (NSTEMI), acute diagnosis and risk stratification can often prove challenging. This review will cover guidelines and strategies for risk assessment, contemporary approaches to acute patient management as well as recommendations for timing of specialist referral.     

Natriuretic peptide testing: a window into the diagnosis and prognosis of heart failure

B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels can indicate a variety of heart problems, as well as general critical illness. BNP and NT-proBNP assays are useful for evaluating patients with acute dyspnea, as a low level of natriuretic peptide can help rule out congestive heart failure (CHF) and reduce reliance on echocardiography. Conversely, these assays can be particularly useful in recognizing CHF in a patient with acute dyspnea and a history of chronic obstructive pulmonary disease. However, clinical judgment must always be part of the evaluation of BNP or NT-proBNP assay results.     

2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging—Best Practices for Safety and Effectiveness,Part 2: Radiological Equipment Operation,Dose‐Sparing Methodologies,Patient and Medical Personnel Protection

The stimulus to create this document was the recognition that ionizing radiation‐guided cardiovascular procedures are being performed with increasing frequency, leading to greater patient radiation exposure and, potentially, to greater exposure to clinical personnel. While the clinical benefit of these procedures is substantial, there is concern about the implications of medical radiation exposure. ACC leadership concluded that it is important to provide practitioners with an educational resource that assembles and interprets the current radiation knowledge base relevant to cardiovascular procedures. By applying this knowledge base, cardiovascular practitioners will be able to select procedures optimally, and minimize radiation exposure to patients and to clinical personnel. “Optimal Use of Ionizing Radiation in Cardiovascular Imaging ‐ Best Practices for Safety and Effectiveness” is a comprehensive overview of ionizing radiation use in cardiovascular procedures and is published online. To provide the most value to our members, we divided the print version of this document into 2 focused parts. “Part I: Radiation Physics and Radiation Biology” addresses radiation physics, dosimetry and detrimental biologic effects. “Part II: Radiologic Equipment Operation, Dose‐Sparing Methodologies, Patient and Medical Personnel Protection” covers the basics of operation and radiation delivery for the 3 cardiovascular imaging modalities (x‐ray fluoroscopy, x‐ray computed tomography, and nuclear scintigraphy). For each modality, it includes the determinants of radiation exposure and techniques to minimize exposure to both patients and to medical personnel.     

Pre-existing major depression predicts in-hospital cardiac complications after acute myocardial infarction

BACKGROUND: Depression (MDD) and anxiety have been associated with negative long-term outcomes among patients with acute myocardial infarction (MI). OBJECTIVE: The objective of the study was to determine whether MDD and anxiety preceding MI were associated with in-hospital post-MI cardiac complications. METHOD: Subjects (N=129) underwent psychiatric interviews within 72 hours of MI and were evaluated for five in-hospital cardiac complications (recurrent ischemia, ventricular arrhythmia, ventricular arrhythmia requiring intervention, congestive heart failure, and reinfarction). RESULTS: Current (pre-MI) MDD was a significant and independent predictor of all complications except recurrent ischemia on multivariate regression analysis. In contrast, pre-MI anxiety was not associated with complications. CONCLUSION: These findings underscore the importance of identifying and treating MDD in post-MI patients and those at risk for MI.     

Triggers of acute coronary syndromes

Despite recent progress in prevention of coronary heart disease, approximately 50% of the deaths from coronary artery disease continue to occur out of hospital, and many major cardiac events occur in individuals not previously known to be at risk. These facts create the need to identify the acute causes of myocardial infarction (MI) and sudden death, which has led to a rapid growth in interest over the last 15 years in the field of triggering research. Since initial observations that the incidence of MI onset was time and activity dependent with circadian, circaseptan, and circannual variation, triggering of MI by heavy exertion, sexual activity, anger, mental stress, cocaine and marijuana use, and exposure to air pollution has been demonstrated. Study of the pathophysiological changes produced by these triggers may provide novel therapeutic and preventive targets by a more thorough understanding of vulnerable plaque disruption and coronary thrombosis.