title: [Clinical practice guidelines of the Spanish Society of Cardiology on unstable angina/infarction without ST elevation].
abstract: This paper up-dates the Clinical Guidelines for Unstable Angina/Non Q wave Myocardial Infarction of the Spanish Society of Cardiology. Due to the increased efficacy of adequate management in the early phases, it has been considered necessary to include recommendations for the pre Hospital and Emergency department phase. Prehospital management. Patients with thoracic pain compatible with myocardial ischemia should be transferred to Hospital as quickly as possible and an ECG tracing performed. Initial management includes rest, sublingual nitroglycerin and aspirin. In the Emergency department. Immediate clinical attention and accessibility to a defibrillator should be available. If ECG tracing discloses ST elevation reperfusion strategy is to be implemented immediately. If no ST elevation is present, the probability of myocardial ischemia and risk factor evaluation is essential for adequate management. A simplified risk stratification classification is presented, that also determines the most adequate site for admission: Coronary Care Unit if high risk factors are present, Cardiology ward for the intermediate risk patient and ambulatory treatment if low risk. Management in Coronary Care Unit. Includes routine ECG monitoring and analgesia. Antithrombotic and anti ischemic treatment include new indication for GP IIb-IIIa and Low molecular weight heparins. Coronary arteriography and revascularisation are recommended, if refractory or recurrent angina, left ventricles dysfunction or other complications are present. Management in the ward is based on adequate chronic medical treatment, risk stratification, and secondary prevention strategy. Coronary arteriography before discharge must be considered in the light of the result of non-invasive tests.
authors.affiliation: Servicio de Cardiología, Fundación Hospital Alcorcón, Madrid. llopez@fhalcorcon.es
authors.forename: L
authors.initials: L
authors.lastname: López Bescós
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.forename: H
authors.initials: H
authors.lastname: Bueno Zamora
authors.forename: I
authors.initials: I
authors.lastname: Coma Canella
authors.forename: R M
authors.initials: RM
authors.lastname: Lidón Corbi
authors.forename: A
authors.initials: A
authors.lastname: Cequier Fillat
authors.forename: J
authors.initials: J
authors.lastname: Tuñón Fernández
authors.forename: R
authors.initials: R
authors.lastname: Masiá Martorell
authors.forename: J
authors.initials: J
authors.lastname: Marrugat de la Iglesia
authors.forename: M
authors.initials: M
authors.lastname: Palencia Pérez
authors.forename: A
authors.initials: A
authors.lastname: Loma-Osorio
authors.forename: J
authors.initials: J
authors.lastname: Bayón Fernández
authors.forename: F
authors.initials: F
authors.lastname: Arós Borau
mesh_terms: D000789:Angina, Unstable / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017023:Coronary Angiography; D004562:Electrocardiography; D004630:Emergencies; D006760:Hospitalization; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment