SearchDiagnosing Acute Coronary Syndrome
Diagnosing acute coronary syndrome
The classic symptom of acute coronary syndrome (ACS) is acute chest pain, usually localised behind the sternum or experienced over a more diffuse area, such as across the anterior chest. Pain from ACS often radiates to the left arm or to both arms, as well as to the shoulders, back, and jaw. Patients typically describe the pain as crushing, squeezing, pressing, or burning.51, 52 Women are more likely than men to present with symptoms other than chest pain. Such symptoms may include dyspnoea, nausea, vomiting, fatigue, indigestion, sweating, and pain localised in the arm or shoulder.53
Diagnosing ACS — assessing the need for emergent intervention
Initial diagnosis of ACS is based on patient history, electrocardiography, and measurement of blood levels of the cardiac biomarkers CK-MB and troponin. Levels of these biomarkers are elevated when there is myocardial injury. These studies help differentiate patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) who need emergent revascularisation procedures from other patients with ACS for whom less aggressive intervention may be appropriate.51, 52
In addition, imaging studies used in ACS for risk stratification and treatment planning include23, 51:
- Echocardiography to assess ventricular function
- Coronary angiography, the current gold standard for visualising coronary artery lesions (and for revascularisation by balloon angioplasty with stent placement)
- CT angiography
- MR angiography
ECG showing NSTEMI
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Windows Live- 51 - Anderson JL. ST segment elevation myocardial infarction and complications of myocardial infarction. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007. Available at www.mdconsult.com. Accessed February 12, 2008.
- 52 - Waters DH. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, PA: Saunders Elsevier; 2007. Available at www.mdconsult.com. Accessed February 12, 2008.
- 53 - Milner KA, Funk M, Richards S, Wilmes RM, Vaccarino V, Krumholz HM. Gender differences in symptom presentation associated with coronary heart disease. Am J Cardiol. 1999;84(4):396-399.
- 23 - Bassand JP, Hamm CW, Ardissino D, et al; Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28(13):1598-1660.
- Acute coronary syndrome
- This is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischaemia (chest pain due to insufficient blood supply to the heart muscle that results from coronary artery disease). Acute coronary syndrome covers the spectrum of clinical conditions ranging from unstable angina to STEMI and NSTEMI.
- Myocardial infarction
- Destruction of heart tissue due to reduced blood flow to the heart. Also known as a heart attack. It usually results from coronary artery disease and is more severe than angina.
- Angiography
- Angiography is imaging of the blood vessels using X-rays or magnetic resonance tomography. The vessels are visualised by injecting contrast medium into a vein. Angiography is used to diagnose disorders of the blood vessels.
