Mount Sinai Cardiologist Helps Create Best Practices for Managing Heart Attack Patients Without Significant Signs of Attack
New algorithm aims to establish more streamlined and individualized patient care
For the first time in the United States, doctors with the American Heart Association 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, or MINOCA. The new document, published in the March 27 issue of Circulation, 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, MD, 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;” Dr Tamis-Holland explains. “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 aheart 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,” adds Dr. 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.”
About the Mount Sinai Health System
Mount Sinai Health System is one of the nation’s leading integrated academic health systems and one of the largest in the New York metropolitan area. Its comprehensive system includes seven hospitals, more than 400 outpatient practices, over 600 research and clinical laboratories, the Icahn School of Medicine at Mount Sinai, the Graduate School of Biomedical Sciences, and the Mount Sinai Phillips School of Nursing. Together, the Health System comprises approximately 48,000 employees, more than 9,000 physicians, and 8,600 nurses.
As a leading learning health system, Mount Sinai combines clinical expertise with scientific discovery to improve patient care while training the next generation of health care and biomedical leaders. The Health System provides care across every stage of life, from prenatal care through geriatrics, while advancing personalized medicine through artificial intelligence, data science, and biomedical research.
Mount Sinai is consistently recognized among the nation’s leading academic health systems for patient care, research, and education. The Mount Sinai Hospital is ranked No. 1 in New York by Newsweek and No. 5 on the magazine’s World’s Best Hospitals list. The Icahn School of Medicine at Mount Sinai ranks No. 11 among U.S. medical schools and No. 1 among freestanding medical schools for National Institutes of Health funding, reflecting the strength of its scientific enterprise and leadership in biomedical research.
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