News | Cardiac Diagnostics | April 15, 2019

New Best Practices Help Manage Heart Attack Patients Without Significant Signs

New algorithm aims to establish more streamlined and individualized patient care

New Best Practices Help Manage Heart Attack Patients Without Significant Signs

April 15, 2019 — For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices for cardiologists to evaluate and manage patients who have heart attacks with no significant signs of coronary artery disease — a condition known as myocardial infarction with non-obstructive coronary arteries (MINOCA). The new document, published in the March 27 issue of Circulation,1 aims to help physicians better recognize patients with this condition, to avoid common misdiagnoses and streamline care. It is especially important for women, who represent a disproportionate number of MINOCA cases.

Jacqueline Tamis-Holland, M.D., associate professor of medicine at the Icahn School of Medicine at Mount Sinai, and associate director of the Mount Sinai St. Luke’s Cardiac Catheterization Lab, led a team of cardiologists from across the world with expertise in caring for patients with MINOCA, to publish this consensus document identifying the best practices.

Until now, the management of patients with suspected MINOCA has varied. There is no clear consensus in clinical practice on addressing and managing these cases, leading to inadequate treatment and potentially putting patients at risk of reoccurrence.

“It is not uncommon for clinicians to misinform their patients regarding their chest pain syndrome,” Tamis-Holland explained. “Unfortunately some patients who have chest pain and elevated heart enzymes, but do not have severe narrowing of their arteries are told that they did not have a heart attack, and this is often an incorrect diagnosis. As a result, doctors often send these patients home without protective medications and don’t tell them about preventive measures.”

The team of cardiologists created an algorithm to develop this new standard of care. Steps are as follows:

  1. First, review the clinical presentation and ensure that the patient did indeed have evidence of a heart attack. This generally requires symptoms and/or changes as well as an elevation in the enzymes. An elevation in the heart enzymes alone without symptoms or electrocardiogram (ECG) changes is usually not considered a heart attack.  
  2. Exclude conditions that might mimic a heart attack.
  3. If the findings indeed support a heart attack and not another diagnosis, then consider the various causes. This may require additional testing or investigations.
  4. Once the evaluation is complete, ensure that patients receive proper education regarding their condition and provide appropriate therapies to treat the underlying cause of the heart attack.

“This document is a reminder to all physicians that the absence of obstructive coronary artery disease does not exclude the diagnosis of a heart attack. In these cases doctors must consider additional evaluations,” added Tamis-Holland. “We hope this document will provide useful information to clinicians caring for patients with MINOCA, leading to standardized care across the United States, and ultimately pave the way for research focused on etiologic based treatment and prognosis for patients with MINOCA.”

For more information: www.ahajournals.org/journal/circ

 

Reference

1. Tamis-Holland J.E., Jneid H., Reynolds H.R., et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation, March 27, 2019. https://doi.org/10.1161/CIR.0000000000000670

Related Content

FDA Warns Troponin Tests Impacted by Biotin Dietary Supplement
Feature | Cardiac Diagnostics | November 05, 2019 | Dave Fornell, Editor
November 5, 2019 — The U.S.
Videos | Cardiac Diagnostics | October 29, 2019
Doctor Clyde Yancy was a keynote speaker and said doctors need to check their assumptions about patients at the door...
79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event

79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event. Image courtesy of University Hospitals.

News | Cardiac Diagnostics | October 16, 2019
Health and wellness screenings are more than just nice events for the community – they can save lives. A Mentor, Ohio,...
Pesticide Exposure May Increase Heart Disease and Stroke Risk

Image courtesy of zefe wu from Pixabay

News | Cardiac Diagnostics | October 15, 2019
On-the-job exposure to high levels of pesticides raised the risk of heart disease and stroke in a generally healthy...
World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...
Insomnia Tied to Higher Risk of Heart Disease and Stroke

Image courtesy of the American Heart Association

News | Cardiac Diagnostics | August 19, 2019
People suffering from insomnia may have an increased risk of coronary artery disease, heart failure and stroke,...
Evolutionary Gene Loss May Help Explain Human Predisposition to Heart Attacks
News | Cardiac Diagnostics | July 29, 2019
The loss of a single gene two to three million years ago in our ancestors may have resulted in a heightened risk of...
U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
Overlay Init