Acute coronary syndrome

acute coronary syndromesheart attack. Acute Coronary Syndromeacute coronary syndrome (ACS)cardiac dysfunctionheart muscle damage
Acute coronary syndrome (ACS) is a syndrome (set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.wikipedia
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Chest pain

chest painschest tightnesschest
The most common symptom is chest pain, often radiating to the left shoulder or angle of the jaw, crushing, central and associated with nausea and sweating. As it is only one of the many potential causes of chest pain, the patient usually has a number of tests in the emergency department, such as a chest X-ray, blood tests (including myocardial markers such as troponin I or T, and H-FABP and/or a D-dimer if a pulmonary embolism is suspected), and telemetry (monitoring of the heart rhythm).
Serious and relatively common causes include acute coronary syndrome such as a heart attack (31%), pulmonary embolism (2%), pneumothorax, pericarditis (4%), aortic dissection (1%), and esophageal rupture.

Unstable angina

pre-infarct anginaunstableunstable angina pectoris
Acute coronary syndrome is commonly associated with three clinical manifestations, named according to the appearance of the electrocardiogram (ECG): ST elevation myocardial infarction (STEMI, 30%), non-ST elevation myocardial infarction (NSTEMI, 25%), or unstable angina (38%).
It is also classified as a type of acute coronary syndrome (ACS).

Angina

angina pectorischest painstable angina
ACS should be distinguished from stable angina, which develops during physical activity or stress and resolves at rest.
Worsening angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome).

Shortness of breath

dyspnearespiratory distressdyspnoea
This may be associated with diaphoresis (sweating), nausea and vomiting, as well as shortness of breath.
Acute coronary syndrome frequently presents with retrosternal chest discomfort and difficulty catching the breath.

Angor animi

Some may report palpitations, anxiety or a sense of impending doom (angor animi) and a feeling of being acutely ill. The description of the chest discomfort as a pressure has little utility in aiding a diagnosis as it is not specific for ACS.
Most cases of angor animi are found in patients suffering from acute coronary syndrome (cardiac related chest pain) such as myocardial infarction.

Troponin

troponin complexTroponin testcardiac troponins
As it is only one of the many potential causes of chest pain, the patient usually has a number of tests in the emergency department, such as a chest X-ray, blood tests (including myocardial markers such as troponin I or T, and H-FABP and/or a D-dimer if a pulmonary embolism is suspected), and telemetry (monitoring of the heart rhythm).
Assays of cardiac-specific troponins I and T are extensively used as diagnostic and prognostic indicators in the management of myocardial infarction and acute coronary syndrome.

Hypertensive crisis

hypertensive criseshigh blood pressurehypertension
Chest pain with features characteristic of cardiac origin (angina) can also be precipitated by profound anemia, brady- or tachycardia (excessively slow or rapid heart rate), low or high blood pressure, severe aortic valve stenosis (narrowing of the valve at the beginning of the aorta), pulmonary artery hypertension and a number of other conditions.
Chest pain may indicate heart muscle damage (which may progress to myocardial infarction) or sometimes aortic dissection, the tearing of the inner wall of the aorta.

Ticagrelor

People with presumed ACS are typically treated with aspirin, clopidogrel or ticagrelor, nitroglycerin, and if the chest discomfort persists morphine. The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists.
Another study compared ticagrelor and clopidogrel in patients with acute coronary syndrome (PLATO Trial) revealed that patients treated with Ticagrelor had a lower risk of infection-related deaths.

Clopidogrel

Plavix
People with presumed ACS are typically treated with aspirin, clopidogrel or ticagrelor, nitroglycerin, and if the chest discomfort persists morphine. The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists.
Clopidogrel is used to prevent heart attack and stroke in people who are at high risk of these events, including those with a history of myocardial infarction and other forms of acute coronary syndrome, stroke, and those with peripheral artery disease.

Randomized controlled trial

randomized controlled trialsrandomized clinical trialrandomized control trial
For example, according to a randomized controlled trial, males having chest pain with normal or non diagnostic ECG are at higher risk for having acute coronary syndrome than women.

Heparin

unfractionated heparinHeparin sodiumVitrum AB
The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists.

Enoxaparin sodium

enoxaparinLovenox
The heparin-like drug known as fondaparinux appears to be better than enoxaparin.
It is also used in those with acute coronary syndrome (ACS) and heart attacks.

Nitrous oxide

laughing gasN 2 Onitrous
Other analgesics such as nitrous oxide are of unknown benefit.
Inhalation of nitrous oxide is used frequently to relieve pain associated with childbirth, trauma, oral surgery and acute coronary syndrome (includes heart attacks).

Prasugrel

The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists.
Prasugrel was approved for use in Europe in February 2009, and in the US in July 2009, for the reduction of thrombotic cardiovascular events (including stent thrombosis) in people with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI).

Coronary CT angiography

coronary computed tomographic angiography
Coronary CT angiography combined with Troponin levels is also helpful to triage those who are susceptible to ACS.
Therefore, the technique is able to identify characteristics of coronary artery disease that are associated to the development of acute coronary syndrome.

Myocardial infarction

heart attackheart attacksacute myocardial infarction
Acute coronary syndrome is commonly associated with three clinical manifestations, named according to the appearance of the electrocardiogram (ECG): ST elevation myocardial infarction (STEMI, 30%), non-ST elevation myocardial infarction (NSTEMI, 25%), or unstable angina (38%). However, NSTEMI had significantly more "major cardiac events" (death, myocardial infarction, disabling stroke, or requiring revascularization) at one year (24.0% vs 16.6%).
It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart.

Stroke

ischemic strokestrokescerebrovascular accident
However, NSTEMI had significantly more "major cardiac events" (death, myocardial infarction, disabling stroke, or requiring revascularization) at one year (24.0% vs 16.6%).
With the availability of treatments which can reduce stroke severity when given early, many now prefer alternative terminology, such as brain attack and acute ischemic cerebrovascular syndrome (modeled after heart attack and acute coronary syndrome, respectively), to reflect the urgency of stroke symptoms and the need to act swiftly.

Kounis syndrome

Allergic acute coronary syndrome
* Allergic acute coronary syndrome (Kounis syndrome)
Kounis syndrome is defined as acute coronary syndrome (symptoms such as chest pain relating to reduced blood flow to the heart) caused by an allergic reaction or a strong immune reaction to a drug or other substance.

Low molecular weight heparin

low-molecular weight heparinlow-molecular-weight heparinLMWH
The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, a second platelet inhibitor such as clopidogrel, prasugrel or ticagrelor, and heparin (usually a low-molecular weight heparin), with intravenous nitroglycerin and opioids if the pain persists.
More recently these agents have been evaluated as anticoagulants in acute coronary syndrome (ACS) managed by percutaneous intervention (PCI).

TIMI

Thrombolysis In Myocardial InfarctionThrombosis in Myocardial Infarction
Combination of troponin levels (less than 5 ng/l) with low TIMI scores can help to predict those with low possibility of myocardial infarction and discharge them safely from the emergency department.
'TIMI risk' estimates mortality following acute coronary syndromes.

Glycogen phosphorylase isoenzyme BB

GPBB
The enzyme is one of the "new cardiac markers" which are discussed to improve early diagnosis in acute coronary syndrome.

Killip class

The Killip classification consists of 4 classes based on clinical symptoms.
Killip class 1 and no evidence of hypotension or bradycardia, in patients presenting with acute coronary syndrome, should be considered for immediate IV beta blockade.

Syndrome

syndromesgenetic syndromessyndromic
Acute coronary syndrome (ACS) is a syndrome (set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.

Medical sign

signsclinical signsign
Acute coronary syndrome (ACS) is a syndrome (set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.

Symptom

symptomsnon-specific symptomssymptomatic
Acute coronary syndrome (ACS) is a syndrome (set of signs and symptoms) due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.