ACUTE CORONARY SYNDROME Review of diagnosis and management of Acute Coronary Syndrome



Review of diagnosis and management of Acute Coronary Syndrome

Introduction

The term Acute Coronary Syndrome (ACS) describes a spectrum of cardiovascular disease that of the Unstable Angina (UA) to the two major forms of heart attack, the Non-ST-Elevation Myocardial Infarction (NSTEMI) and ST Elevation Myocardial Infarction (STEMI), ranges. Cause of the acute event is a critical reduction of blood flow through the formation of a local thrombus at the bottom of plaque rupture or plaque erosion. In emergency medicine, acute coronary syndrome, the term is used primarily as the primary working diagnosis at a still unclear, acute and long-lasting (<20 min), cardiac symptoms. The working diagnosis is basically out of a life-threatening situation of the affected patients. Possible differential diagnoses for Acute Coronary Syndrome can be diverse in nature, ranging from other cardiovascular diseases (e.g. cardiac arrhythmias, myocarditis), pulmonary diseases (e.g. pulmonary embolism), skeletal diseases (e.g. rib fractures), diseases of the gastro-intestinal tract (e.g. acute pancreatitis, perforated gastric ulcer) to tumors of the skeleton and the chest wall. This paper is a review of the literature on diagnosis and management of Acute Coronary Syndrome.

Discussion

For risk stratification and goal-oriented therapeutic treatment of affected patients, the acute coronary syndrome is well defined in three categories:

ST-Segment Elevation Myocardial Infarction (STEMI).

Non-ST-Elevation Myocardial Infarction (NSTEMI).

Unstable Angina (UA).

An accurate diagnosis is made ??by measuring biochemical markers (especially cardiac troponin T and I) and electrocardiography (ECG). The mutual guidelines of the American Heart Association (AHA) and the American College of Cardiology (ACC) prefer to receive the final diagnoses Non-Q-Wave Myocardial Infarction (NQMI) or Q-Wave Myocardial Infarction (QWMI).

ST-Segment Elevation Myocardial Infarction:

The ST-Elevation Myocardial Infarction is assumed if any of the following ECG findings:

ST-segment elevation of = 0.1 mV in at least two contiguous limb leads.

ST-segment elevation of = 0.2 mV in at least two contiguous chest leads.

Left bundle branch block with typical symptoms of myocardial infarction.

Non-ST-Elevation Myocardial Infarction and Unstable Angina pectoris:

The ECG has no ST elevation, is from a Non-ST-Elevation Myocardial Infarction or Unstable Angina pectoris be assumed. An accurate diagnosis can be made at the earliest after 3 hours on the set Troponin. While there are detectable up to 72 hours with NSTEMI slightly increased values ??for the cardiac markers have in unstable angina pectoris, no elevated levels.

Risk Factors:

The first manifestation of acute coronary syndrome is usually preceded by a long-term development. The Atherosclerosis is the disease that is almost all based on cardiovascular events. Various risk factors promote the development and progression of atherosclerosis:

Non-modifiable risk factors:

Age

Gender

Positive family history for cardiovascular disease

Modifiable risk factors:

Smoking

unhealthy diet

Lack of exercise

Stress

Overweight

Diabetes mellitus

high blood sugar levels (HbA1c)

high LDL-C levels (bad cholesterol)

low HDL-C levels (good cholesterol)

elevated triglycerides

High blood pressure

While the hospital mortality was reduced in acute coronary syndrome in recent years, the pre-hospital mortality rate remains extremely high: 37% of patients with myocardial infarction die before reaching the hospital. Initial hospitalizations die within about 3% of the patients from the effects of an acute coronary ...