Symptoms And Treatment Of Acute Coronary Syndrome

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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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