진단 측면
분류 | 안정 협심증(SA) | Acute coronary syndrome (ACS) | 이형 협심증(VA) | ||
UA/NSTEMI | STEMI | ||||
개요 | 병태생리 |
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흉통 | Anginal pain
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Cf. 비전형적 증상. Atypical MI 20%: 어지러움, 호흡곤란, 피로 Painless MI 당뇨병, 노인 → 관상동맥조영술
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진단 | 감별포인트 |
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진단검사 |
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EKG |
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cardiac enzyme |
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관상동맥조영술 |
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치료 측면
- Simple Mnemonic
급성기
| NB(C)-A + BASIC | O-NB(C)A'-STAR + BASIC | O-NBA''-STAR + BASIC |
"NBA 농구는 기본에 충실해야 한다." | "오~NBA 스타가 되려면 기본에 충실해야지" |
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N: Nitrate B: Beta-blocker A: anti-thrombotic - Anti-platelet (C): Calcium antagonist | O: oxygen, opioid N: Nitrate B: Beta-blocker (C): Calcium antagonist A': Anti-platelet (aspirin, P2Y12 inhibitor) + anticoagulant (heparin: UFH, enoxaparin) | O: oxygen, opioid N: Nitrate B: Beta-blocker A'': Anti-platelet (aspirin, P2Y12 inhibitor) + anticoagulant (heparin: UFH, enoxaparin) + thrombolysis (tPA, streptokinase) STA: statin R: revascularization (PCI, CABG) | |
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유지치료 | B: Beta-blocker A: anti-platelet S: statin I: inhibitor of angiotensin II (ACEi or ARB) C: correction of risk factors | B: Beta-blocker A: anti-platelet S: statin I: inhibitor of angiotensin II (ACEi or ARB) C: correction of risk factors | B: Beta-blocker A: anti-platelet S: statin I: inhibitor of angiotensin II (ACEi or ARB) C: correction of risk factors |
- Angina/ischaemiac relief
분류 | stable anginal (or chronic coronary syndrome, CCS) (ESC 2019) | Acute coronary syndrome (ACS) | ||
UA/NSTEMI (ESC 2015/AHA/ACC 2014) | STEMI (ESC 2017) | |||
oxygen |
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Opioid (morphine) |
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BB
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Angina/ischaemiac relief
event prevention: BB
| 급성기
유지기
| 급성기
Cf. CCB: 급성기에 별로 도움이 안되며 속효성 dihydropyridines는 사망률 증가와 연관됨 Cf. 심실하벽 경색이 있는 환자에서 특히 서맥, 고도 전도장애를 일으킬 수 있으며 이 경우 atropine 0.5 mg 정맥투여하면 대개 호전 급성기 이후
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CCB | 급성기/유지기
| 급성기
급성기 이후
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Nitrate |
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| 급성기
급성기 이후
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기타
| ranolazine |
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trimetazidine | ||||
Nicorandil | ||||
ivabradine |
- event prevention or long-term management
분류 | stable anginal (or chronic coronary syndrome, CCS) (ESC 2019) | Acute coronary syndrome (ACS) | |
UA/NSTEMI (ESC 2015/ AHA/ACC 2014) | STEMI (ESC 2017) | ||
항혈소판제 |
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aspirin | sinus rhythm
atrial fibrillation
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| 급성기
Cf. NSAIDs, glucocorticoid: 심근의 회복을 막고 심근의 파열 위험을 증가시키는 등의 위험이 있으므로 금기 유지기
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P2Y12 inhibitor | sinus rhythm
| 급성기/유지기
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유지기
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항응고제 | atrial fibrillation 동반
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Renin-angiotension-aldosterone blocker |
| 유지기
| 급성기/유지기
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statin/다른 지질 강하제 |
| 급성기/유지기
| 급성기/유지기
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MRAs |
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참고자료
- Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromesThe Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 2020;41(3):407–77.
- Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64(24):e139–228.
- Roffi M, Patrono C, Collet J-P, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37(3):267–315.
- Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39(2):119–77.