Diagnosis and management of acute coronary syndromes

Tahir Mian, Brian Allen, Saranjit Kaur

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Heart disease is the number one cause of death in the US. The term acute coronary syndrome encompasses a wide range of manifestations from unstable coronary atherosclerosis: non-exertional chest pain from an unstable plaque to full coronary artery obstruction with ST segment elevation. A thorough history and physical examination, electrocardiogram, and biochemical markers help to establish the diagnosis and degree of ACS. In ST segment elevation myocardial infarction, an electrocardiogram can demonstrate ST elevations, a new left bundle branch block or a posterior myocardial infarction pattern; whereas the lack of these electrocardiographic changes with release of cardiac biomarkers in acute coronary syndrome is referred to as non-ST segment elevation myocardial infarction. Clinical myocardial injury without elevated biomarkers manifest by angina pectoris at rest or with minimal exertion, occurring in a crescendo pattern, or being novel or severe in onset is classically called unstable angina. By determining the extent of injury to a patient, physicians are able to guide appropriate treatment goals based on a risk/benefit ratio. Treatment of acute coronary syndrome includes medical therapy and aggressive management with invasive cardiac procedures. Medical management comprises anti-ischemic therapy, the cornerstones of which are beta-blockers, and antiplatelet agents ranging from aspirin to newer agents such as thienopyridines and glycoprotein IIb-IIIa inhibitors. Other medical management tools include antithrombotic agents such as heparin and HMG-CoA reductase inhibitors such as pravastatin and rosuvastatin. After initiating medical therapy, patients with acute coronary syndrome and high-risk features, such as elevated cardiac biomarkers, unstable symptoms, and ventricular ectopy, benefit from an invasive approach. Intermediate risk patients can be further risk stratified by cardiac stress testing via exercise or pharmacological means. Percutaneous and surgical revascularization plays a prominent role in treating acute coronary syndrome. Cardiac rehabilitation is increasingly recognized in treating patients as well.

Original languageEnglish (US)
Title of host publicationEverything You Need to Know
Subtitle of host publicationOut of the Operating Room and Minimally Invasive Cardiothoracic Procedures
PublisherNova Science Publisher Inc.
Pages3-38
Number of pages36
ISBN (Electronic)9781536129182
ISBN (Print)9781536129175
StatePublished - Jan 1 2018

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Acute Coronary Syndrome
Biomarkers
Unstable Angina
Electrocardiography
Thienopyridines
Therapeutics
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Pravastatin
Platelet Glycoprotein GPIIb-IIIa Complex
Fibrinolytic Agents
Bundle-Branch Block
Platelet Aggregation Inhibitors
Wounds and Injuries
Angina Pectoris
Chest Pain
Aspirin
Physical Examination
Heparin
Coronary Artery Disease
Cause of Death

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mian, T., Allen, B., & Kaur, S. (2018). Diagnosis and management of acute coronary syndromes. In Everything You Need to Know: Out of the Operating Room and Minimally Invasive Cardiothoracic Procedures (pp. 3-38). Nova Science Publisher Inc..

Diagnosis and management of acute coronary syndromes. / Mian, Tahir; Allen, Brian; Kaur, Saranjit.

Everything You Need to Know: Out of the Operating Room and Minimally Invasive Cardiothoracic Procedures. Nova Science Publisher Inc., 2018. p. 3-38.

Research output: Chapter in Book/Report/Conference proceedingChapter

Mian, T, Allen, B & Kaur, S 2018, Diagnosis and management of acute coronary syndromes. in Everything You Need to Know: Out of the Operating Room and Minimally Invasive Cardiothoracic Procedures. Nova Science Publisher Inc., pp. 3-38.
Mian T, Allen B, Kaur S. Diagnosis and management of acute coronary syndromes. In Everything You Need to Know: Out of the Operating Room and Minimally Invasive Cardiothoracic Procedures. Nova Science Publisher Inc. 2018. p. 3-38
Mian, Tahir ; Allen, Brian ; Kaur, Saranjit. / Diagnosis and management of acute coronary syndromes. Everything You Need to Know: Out of the Operating Room and Minimally Invasive Cardiothoracic Procedures. Nova Science Publisher Inc., 2018. pp. 3-38
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