High risk (at least one of the following features must be present): |
History: |
Accelerating tempo of ischemic symptoms in preceding 48 hours |
Character of pain: |
Prolonged ongoing (>20 min) rest pain |
Clinical findings: |
Pulmonary edema, most likely due to ischemia |
New or worsening MR murmur |
S3 or new/worsening rales |
Hypotension, bradycardia, tachycardia |
Age >75 years |
ECG: |
Angina at rest with transient ST-segment changes >0.5 mm |
Bundle-branch block, new or presumed new |
Sustained ventricular tachycardia |
Cardiac markers: |
Elevated cardiac TnT, TnI, or CK-MB (eg, TnT or TnI >0.1 ng per mL) |
Intermediate risk (no high-risk feature but must have one of the following): |
History: |
Prior MI, peripheral or cerebrovascular disease, or CABG; prior aspirin use |
Character of pain: |
Prolonged (>20 min) rest angina, now resolved, with moderate or high likelihood of CAD |
Rest angina (>20 min) or relieved with rest or sublingual NTG |
Nocturnal angina |
New onset or progressive CCS class III or IV angina in the past two weeks without prolonged (>20 min) rest pain but with intermediate or high likelihood of CAD |
Clinical findings: |
Age >70 years |
ECG: |
T-wave changes |
Pathological Q waves or resting ST-depression less than 1 mm in multiple lead groups (anterior, inferior, lateral) |
Cardiac markers: |
Slightly elevated cardiac TnT, TnI, or CK-MB (eg, TnT greater than 0.01 but less than 0.1 ng per mL) |
Low risk (no high- or intermediate-risk features, but may have any of the following features): |
Character of pain: |
Increased angina frequency, severity, or duration |
Angina provoked at a lower threshold |
New onset angina with onset two weeks to two months prior to presentation |
ECG: |
Normal or unchanged ECG |
Cardiac markers: |
Normal |
Do you want to add Medilib to your home screen?