Review of Acute Coronary Syndrome Diagnosis and Management

Abstract

Acute coronary syndrome (ACS) refers to a group of clinical conditions caused by myocardial ischemia including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Appropriate and accurate diagnosis has life-saving implications and requires a quick but thorough evaluation of the patient's history, physical examination, electrocardiogram, radiographic studies, and cardiac biomarkers. The management of patients with suspected or confirmed ACS continues to evolve as new evidence from clinical trials is considered and as new technology becomes available to both primary care physicians and cardiologists. Low- and intermediate-risk patients have frequently been managed in a chest pain center or in the emergency department. While stress testing with or without radionuclide imaging is the most common evaluation method, a CT angiogram is sometimes substituted. High-risk patients are often managed with an early invasive strategy involving left heart catheterization with a goal of prompt revascularization of at-risk, viable myocardium. With the increased availability of cardiac catheterization facilities, patients with STEMI are more commonly being managed with primary percutaneous coronary intervention, although thrombolysis is still used where such facilities are not immediately available. This article provides primary care physicians with a concise review of the pathophysiology, clinical evaluation, and management of ACS based on the best available evidence in 2008.

Differential Characteristics of Patients with Acute Coronary Syndrome without ST-Segment Elevation Compared to those with Transient ST-Segment Elevation

“…The study population was divided into two groups according to the presence or absence of transient ST-segment elevation. ACS was diagnosed according to the criteria found in the literature, 3 and the patients with ST-segment elevation >1 mm on the first electrocardiographic tracing with resolution in less than 30 min in the absence of reperfusion treatment were classified as presenting ACS with transient ST-segment elevation.…”

Atypical case of acute coronary syndrome due to coronary-pulmonary steal syndrome secondary to pulmonary embolism

“…Venco, Dr. Mongiardi, Dr. Dentali: Acute coronary syndromes (ACS) include a group of clinical conditions caused by myocardial ischemia, namely unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Appropriate and accurate diagnosis has life-saving implications, and requires a quick, but thorough evaluation of the patient history, physical examination, electrocardiogram, and cardiac biomarkers [1].…”

Exclusive olive oil consumption has a protective effect on coronary artery disease; overview of the THISEAS study

“…Cases were individuals presenting with either acute coronary syndrome or stable CAD defined as >50 % stenosis in at least one of the three main coronary vessels assessed by coronary angiography. Acute coronary syndrome was defined as acute myocardial infarction ranging from ST-segment (STEMI) to non-ST-segment elevation (NSTEMI) and unstable angina ( 15 ) . Acute coronary syndrome patients had also undergone coronary angiography that verified the presence of significant stenosis.…”