Symptoms And Treatment Of Acute Coronary Syndrome

5520 Words Oct 28th, 2015 23 Pages
CLINICAL CLARIFICATION
• Acute coronary syndrome refers to several potentially life-threatening conditions associated with acute myocardial ischemia and/or infarction most commonly resulting from a sudden decrease in coronary blood flow8, 2
• Includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina
CLASSIFICATION
• Based on electrocardiogram (ECG) 8
○ Acute chest pain and persistent (>20 min) ST-segment elevation
– Defined as ST-elevation acute coronary syndrome (STEACS) and generally indicates acute total coronary occlusion.
– Most developed ST-segment elevation myocardial infarction
○ Acute chest pain without persistent ST-segment elevation
– Accounts for 75% of all cases of acute coronary syndrome 2
– Defined as non-ST-elevation acute coronary syndrome (NSTEACS), further diagnostically refined as:
□ Non-ST-segment elevation myocardial infarction (elevated biomarkers)
□ Unstable angina
– At presentation, ECG reveals:
□ Persistent or transient ST-segment depression, or
□ T-wave inversion
□ Flat T waves
□ Pseudo-normalization of T waves
□ No ECG changes
DIAGNOSIS
CLINICAL PRESENTATION
• History
○ Thorough past medical history essential for suring appropriate diagnosis and management. 2
○ Factors that should be evaluated include:
– Nature of angina symptoms
□ Location, duration, radiation, quality, intensity
□ Provocative factors (ie. activity, emotional stress)
□ Palliating factors (ie. rest, sublingual…
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