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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
Newswise — (New York, NY – March 21, 2019) – 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:
- 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.
- Exclude conditions that might mimic a heart attack.
- If the findings indeed support a heart attack and not another diagnosis, then consider the various causes. This may require additional testing or investigations.
- 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
The Mount Sinai Health System is New York City's largest integrated delivery system encompassing (with the addition of South Nassau Communities Hospital) eight hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.
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