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Encyclopedia > Acute coronary syndrome

An acute coronary syndrome (ACS) is a set of signs and symptoms suggestive of sudden cardiac ischemia, usually caused by disruption of atherosclerotic plaque in an epicardial coronary artery. The acute coronary syndromes include Unstable Angina (UA), Non-ST Segment Elevation Myocardial Infarction (NSTEMI), and ST Segment Elevation Myocardial Infarction (STEMI), commonly referred to as a heart attack. In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ...


ACS should be distinguished from stable angina, which develops during exertion and resolves at rest. In contrast with stable angina, unstable angina occurs suddenly, often at rest or with minimal exertion, or at lesser degrees of exertion than the individual's previous angina ("crescendo angina"). New onset angina is also considered unstable angina, since it suggests a new pathophysiologic process in the coronary artery. angina tonsillaris see tonsillitis. ...

Contents

Signs and Symptoms

The signs and symptoms of ACS may include:

  • chest pain
  • shortness of breath
  • nausea
  • vomiting
  • diaphoresis (sweating)
  • palpitations
  • anxiety or sense of impending doom
  • a feeling of being acutely ill

Diagnosis

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 a D-dimer if a pulmonary embolism is suspected), and telemetry (monitoring of the heart rhythm). In medicine, chest pain is a symptom of a number of conditions and is generally considered a medical emergency, unless the patient is a known angina pectoris sufferer and the symptoms are familiar (appearing at exertion and resolving at rest, known as stable angina). When the chest pain is not... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... Frontal chest X-ray. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ... D-dimer is a blood test performed in the medical laboratory to diagnose thrombosis. ...


ACI-TIPI score

The ACI-TIPI score can be used to aid diagnosis.[1]


Cardiac Biomarkers

According to Lemos, the use of cardiac markers can be divided into two applications; [2]

In general, a diagnosis (plural diagnoses) has two distinct dictionary definitions. ...

Prognosis

TIMI Score

The TIMI risk score can identify high risk patients[3] and has been independently validated.[4][5] We dont have an article called Timi Start this article Search for Timi in. ...


Biomarkers for Diagnosis

The aim of diagnostic markers is to identify patients with ACS even when there is no evidence of myocyte necrosis.

  • Ischemia-Modified Albumin (IMA) - In cases of Ischemia - Albumin undergoes a conformational change and loses its ability to bind transitional metals (copper or cobalt). IMA can be used to assess the proportion of modified albumin in ischemia. Its use is limited to ruling out ischemia rather than a diagnostic test for the occurrence of ischemia.
  • Myeloperoxidase (MPO) - The levels of circulating MPO, a leukocyte enzyme, elevate early after ACS and can be used as an early marker for the condition.
  • Glycogen Phosphorylase Isoenzyme BB-(GPBB) is an early marker of cardiac ischemia and is one of three isoenzymeof Glycogen Phosphorylase.

Isozymes (also known as isoenzymes) are enzymes that differ in amino acid sequence but catalyze the same chemical reaction. ... Troponin Troponin is a complex of three proteins that is integral to muscle contraction in skeletal and cardiac muscle, but not smooth muscle. ... ACS is a three-letter acronym that may refer to: // American Cancer Society, an American medical organization American Chemical Society, an American professional association American Colonization Society American Community Survey, a project of the U.S. Census Bureau American Constitution Society for Law and Policy, or simply American Constitution Society...

Biomarkers for Risk Stratification

The aim of prognostic markers is to reflect different components of pathophysiology of ACS. For example:

  • Natriuretic peptide - Both B-type natriuretic peptide (BNP) and N-terminal Pro BNP can be applied to predict the risk of death and heart failure following ACS.
  • Monocyte chemo attractive protein (MCP)-1 - has been shown in a number of studies to identify patients with a higher risk of adverse outcomes after ACS.

Treatment

STEMI

Main article: Myocardial infarction

If the ECG confirms changes suggestive of myocardial infarction (ST elevations in specific leads, a new left bundle branch block or a true posterior MI pattern), thrombolytics may be administered or primary coronary angioplasty may be performed. In the former, medication is injected that stimulates fibrinolysis, destroying blood clots obstructing the coronary arteries. In the latter, a flexible catheter is passed via the femoral or radial arteries and advanced to the heart to identify blockages in the coronaries. When occlusions are found, they can be intervened upon mechanically with angioplasty and perhaps stent deployment if a lesion, termed the culprit lesion, is thought to be causing myocardial damage. Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Thrombolytic drugs are used in medicine to dissolve blood clots in a procedure termed thrombolysis. ... This article does not cite any references or sources. ... Fibrinolysis is the process where a fibrin clot, the product of coagulation, is broken down. ... The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart. ... Section of an artery An artery or arterial is also a class of highway. ... This article does not cite any references or sources. ... Endoscopic image of self-expanding metallic stent in esophagus, which was used to palliatively treat esophageal cancer. ...


NSTEMI and NSTE-ACS

If the ECG does not show typical changes, the term "non-ST segment elevation ACS" is applied. The patient may still have suffered a "non-ST elevation MI" (NSTEMI). The accepted management of unstable angina and acute coronary syndrome is therefore empirical treatment with aspirin, heparin (usually a low-molecular weight heparin such as enoxaparin) and clopidogrel, with intravenous glyceryl trinitrate and opioids if the pain persists. Aspirin, or acetylsalicylic acid (IPA: ), (acetosal) is a drug in the family of salicylates, often used as an analgesic (to relieve minor aches and pains), antipyretic (to reduce fever), and as an anti-inflammatory. ... Heparin, a highly sulfated glycosaminoglycan is widely used as an injectable anticoagulant and has the highest negative charge density of any known biological molecule. ... In medicine, low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis. ... Enoxaparin is a low molecular weight heparin manufactured by Sanofi-Aventis. ... Clopidogrel (IPA: ) is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... Glyceryl trinitrate (GTN) is the pharmaceutical name for nitroglycerin. ... An opioid is a chemical substance that has a morphine-like action in the body. ...


A blood test is generally performed for cardiac troponins twelve hours after onset of the pain. If this is positive, coronary angiography is typically performed on an urgent basis, as this is highly predictive of a heart attack in the near-future. If the troponin is negative, a treadmill exercise test or a thallium scintigram may be requested. A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. ...


Prevention

Acute coronary syndrome often reflects a degree of damage to the coronaries by atherosclerosis. Primary prevention of atherosclerosis is controlling the risk factors: healthy eating, exercise, treatment for hypertension and diabetes, avoiding smoking and controlling cholesterol levels); in patients with significant risk factors, aspirin has been shown to reduce the risk of cardiovascular events. Secondary prevention is discussed in myocardial infarction. This article does not cite any references or sources. ... For other forms of hypertension, see Hypertension (disambiguation). ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... The cigarette is the most common method of smoking tobacco. ... Cholesterol is a sterol (a combination steroid and alcohol), a lipid found in the cell membranes of all body tissues, and is transported in the blood plasma of all animals. ... Aspirin, or acetylsalicylic acid (IPA: ), (acetosal) is a drug in the family of salicylates, often used as an analgesic (to relieve minor aches and pains), antipyretic (to reduce fever), and as an anti-inflammatory. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ...


References

  1. ^ Selker HP, Griffith JL, D'Agostino RB (1991). "A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use. A time-insensitive predictive instrument (TIPI) for acute cardiac ischemia: a multicenter study". Medical care 29 (7): 610-27. PMID 2072767. 
  2. ^ James De Lemos, MD (2006). Cardiovascular Biomarkers for Acute Corony Syndromes Using a Multi-Marker Strategy.
  3. ^ Antman EM, Cohen M, Bernink PJ, et al (2000). "The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making". JAMA 284 (7): 835-42. PMID 10938172. 
  4. ^ Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE (2006). "Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population". Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 13 (1): 13-8. DOI:10.1197/j.aem.2005.06.031. PMID 16365321. 
  5. ^ Chase M, Robey JL, Zogby KE, Sease KL, Shofer FS, Hollander JE (2006). "Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population". Annals of emergency medicine 48 (3): 252-9. DOI:10.1016/j.annemergmed.2006.01.032. PMID 16934646. 

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