Signs and symptoms
Atherosclerosis is the primary cause of ACS, with most cases occurring from the disruption of a previously nonsevere lesion. Complaints reported by patients with ACS include the following:
- Palpitations
- Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm
- Exertional dyspnea that resolves with pain or rest
- Diaphoresis from sympathetic discharge
- Nausea from vagal stimulation
- Decreased exercise tolerance
Physical findings can range from normal to any of the following:
- Hypotension: Indicates ventricular dysfunction due to myocardial ischemia, myocardial infarction (MI), or acute valvular dysfunction
- Hypertension: May precipitate angina or reflect elevated catecholamine levels due to anxiety or to exogenous sympathomimetic stimulation
- Diaphoresis
- Pulmonary edema and other signs of left heart failure
- Extracardiac vascular disease
- Jugular venous distention
- Cool, clammy skin and diaphoresis in patients with cardiogenic shock
- A third heart sound (S3) and, frequently, a fourth heart sound (S4)
- A systolic murmur related to dynamic obstruction of the left ventricular outflow tract
- Rales on pulmonary examination (suggestive of left ventricular dysfunction or mitral regurgitation)
Potential complications include the following:
- Ischemia: Pulmonary edema
- Myocardial infarction: Rupture of the papillary muscle, left ventricular free wall, and ventricular septum
Diagnosis
Updated guidelines for the management of non-ST-segment elevation ACS were released in 2020 by the European Society of Cardiology (ESC). [1] The updates place increased reliance on high-sensitivity cardiac troponin testing (hs-cTn) for diagnosis. The guidelines include the use of the CRUSADE risk score (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation) of the ACC/AHA guidelines.
In the emergency setting, electrocardiography (ECG) is the most important diagnostic test for angina. ECG changes that may be seen during anginal episodes include the following:
- Transient ST-segment elevations
- Dynamic T-wave changes: Inversions, normalizations, or hyperacute changes
- ST depressions: These may be junctional, downsloping, or horizontal
Laboratory studies that may be helpful include the following:
- Creatine kinase isoenzyme MB (CK-MB) levels
- Cardiac troponin levels
- Myoglobin levels
- Complete blood count
- Basic metabolic panel
Diagnostic imaging modalities that may be useful include the following:
- Chest radiography
- Echocardiography
- Myocardial perfusion imaging
- Cardiac angiography
- Computed tomography, including CT coronary angiography and CT coronary artery calcium score
Management
Initial therapy focuses on the following:
- Stabilizing the patient’s condition
- Relieving ischemic pain
- Providing antithrombotic therapy
Pharmacologic anti-ischemic therapy includes the following:
- Nitrates (for symptomatic relief)
- Beta blockers (eg, metoprolol): These are indicated in all patients unless contraindicated
Pharmacologic antithrombotic therapy includes the following:
- Aspirin
- Clopidogrel
- Prasugrel
- Ticagrelor
- Glycoprotein IIb/IIIa receptor antagonists (abciximab, eptifibatide, tirofiban)
Pharmacologic anticoagulant therapy includes the following:
- Unfractionated heparin (UFH)
- Low-molecular-weight heparin (LMWH; dalteparin, nadroparin, enoxaparin)
- Factor Xa inhibitors (rivaroxaban, fondaparinux)
Additional therapeutic measures that may be indicated include the following:
- Thrombolysis
- Percutaneous coronary intervention (preferred treatment for ST-elevation MI)
Current guidelines for patients with moderate- or high-risk ACS include the following:
- Early invasive approach
- Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or LMWH
I’m amazed, I have to admit. Sеldom do I encountеr
a Ƅlog that’s both equally educative and engaging, and let me tell you, you haѵe
hit thе nail on the head. Thе issue is something not enough men and women are ѕpeaking
intelligently aЬout. I’m very hapⲣy that
I came acrοss this during my search for something гelating to
this.
Great post. I used to be checking constantly this weblog and I’m
impressed! Very helpful info specifically the ultimate part 🙂 I care for such information much.
I used to be seeking this certain info for a
long time. Thank you and best of luck.
I all the time used to read article in news papers
but now as I am a user of internet therefore from now I am
using net for content, thanks to web.
Greetings from Colorado! I’m bored at work so I decided to check out your blog on my iphone during lunch break.
I love the information you provide here and can’t
wait to take a look when I get home. I’m amazed at how fast your blog
loaded on my mobile .. I’m not even using WIFI, just 3G ..
Anyhow, amazing blog!
Wow, awesome weblog format! How long have you ever been blogging for?
you made blogging look easy. The whole look of your web site is excellent,
let alone the content material!
Excellent goods from you, man. I have understand your
stuff previous to and you’re just extremely excellent. I actually like what you’ve acquired here, certainly like what you’re saying and the
way in which you say it. You make it enjoyable and you still care for to keep it wise.
I can’t wait to read much more from you. This is actually a great website.
If some one desires to be updated with most up-to-date technologies
after that he must be pay a quick visit this web site and be up to date every day.
I do not even know how I ended up here, but I thought this post was great. I don’t know who you are but definitely you’re going to a famous blogger if you are not already 😉 Cheers!
Great post. I am facing a couple of these problems.
Perfect work you have done, this site is really cool with excellent information.
Good write-up. I absolutely love this site. Stick with it!
I love your blog.. very nice colors & theme. Did you create this website yourself? Plz reply back as I’m looking to create my own blog and would like to know wheere u got this from. thanks
I just could not depart your web site prior to suggesting that I really enjoyed the standard information a person provide for your visitors? Is gonna be back often to check up on new posts
I was very pleased to uncover this great site. I need to to thank you for ones time due to this fantastic read!! I definitely enjoyed every bit of it and I have you book-marked to see new things in your website.
I’ll immediately grab your rss feed as I can not in finding your e-mail subscription link or e-newsletter service. Do you have any? Please let me recognize so that I may just subscribe. Thanks.
I precisely desired to thank you very much once again. I do not know what I could possibly have sorted out in the absence of these secrets shared by you directly on such field. Entirely was the frustrating issue in my view, nevertheless considering the expert avenue you resolved the issue made me to jump for contentment. Now i’m happy for this assistance as well as hope that you comprehend what a powerful job you are always doing instructing people today through the use of a site. I am certain you haven’t encountered all of us.
I am always thought about this, thanks for posting.
Hi there, just became alert to your blog through Google, and found that it is truly informative. I am going to watch out for brussels. I will be grateful if you continue this in future. Numerous people will be benefited from your writing. Cheers!
why not sir?
obviously like your website but you need to check the spelling on several of your posts. Many of them are rife with spelling problems and I find it very troublesome to tell the truth nevertheless I will surely come back again.
Can I just say what a relief to find someone who actually knows what theyre talking about on the internet. You definitely know how to bring an issue to light and make it important. More people need to read this and understand this side of the story. I cant believe youre not more popular because you definitely have the gift.
Hi to all, the contents present at this web page are actually awesome for people experience, well, keep up the good work fellows.