Acute Coronary Syndrome
Acute Coronary Syndrome is “bread and butter” emergency medicine - Daniel Kreider MD
image by: Armando Hasudungan
Accurate and expeditious diagnosis of acute myocardial infarction or acute coronary syndrome (ACS) is one of the key charges of emergency medicine providers. Chest pain is the second most common reason for emergency department visits in the United States and coronary artery disease is our leading cause of death.
Up until the late 1980s, most patients presenting to the emergency department (ED) with chest pain were simply admitted to a coronary care unit (CCU). Some of these patients had acute myocardial infarction (MI) and were treated accordingly. However, the majority were low risk patients admitted simply to monitor for the development of acute MI with serial ECGs and cardiac enzyme…
Observation units were developed in the 1990s to help hospitals save money. We did not have the sophisticated scoring systems or lab tests that we have today, therefore we needed 12 to 24 hours to rule out MI in patients presenting with chest pain, and we needed somewhere to do this outside of a CCU. This is no longer the case. We can safely rule out MI in 3-4 hours in the ED with contemporary troponin testing.
Up until the late 1980s, most patients presenting to the emergency department (ED) with acute chest pain were simply admitted to a coronary care unit (CCU) (3). Some of these patients had acute MI and were treated accordingly. However, the majority were low risk patients admitted simply to monitor for the development of acute MI with serial ECGs and cardiac enzyme measurement (CK-MB at that time). Over half the patients admitted to the CCU with acute chest pain were eventually “ruled out” for myocardial infarction (4). Admission of these “rule out MI” patients to an intensive care unit was costly, leading hospitals to seek ways of distinguishing the low risk patients earlier.
Use in patients ≥21 years old presenting with symptoms suggestive of ACS. Do not use if new ST-segment elevation ≥1 mm or other new EKG changes, hypotension, life expectancy less than 1 year, or noncardiac medical/surgical/psychiatric illness determined by the provider to require admission.
Many patients undergoing major noncardiac as well as vascular surgery are at risk for a major adverse cardiac event (MACE).
Estimates mortality in patients with STEMI.
Chest pain is the leading complaint for ED visits in the United States (estimated 5-8 million presentations annually). Acute coronary syndrome (ACS) represents the continuum of disease representing decreased coronary blood flow and acute myocardial ischemia and/or infarction. This decreased flow is abrupt in nature. The ACS continuum consists of unstable angina, non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). ACS is a mix of reversible and irreversible cardiac ischemia. The large majority of patients that come to the ED with chest pain, will not have ACS...
Acute coronary syndromes (ACS) include conditions that share the same pathophysiology of myocardial ischaemic states, i.e., unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
Acute coronary syndrome (ACS) is a catch all term that refers to ischemic symptoms resulting from acute coronary occlusion.
The term 'acute coronary syndrome' (ACS) covers a range of disorders, including a heart attack (myocardial infarction) and unstable angina, that are caused by the same underlying problem. Unstable angina occurs when the blood clot causes a reduced blood flow but not a total blockage. T
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