SHM's Clinical Quick Talks-Acute Coronary Syndrome

Pdf Summary

The document "Acute Coronary Syndrome: A Pain in the Chest" by Dr. Jeffrey Wagner focuses on the identification, management, and treatment of Acute Coronary Syndrome (ACS). ACS predominantly arises from obstructive coronary artery disease (CAD) with plaque ruptures leading to thrombus formation; risk factors include advanced age, male gender, family history, diabetes, hypertension, hyperlipidemia, and tobacco use. A minority of cases involve non-obstructive causes like coronary vasospasm, stress cardiomyopathy, and spontaneous coronary artery dissection (SCAD).<br /><br />Patients can present with either high-probability symptoms (central retrosternal pressure and exertional pain radiating to arms) or low-probability symptoms (sharp, burning, pleuritic, or positional pain). Differential diagnoses for chest pain in the emergency department are varied, with ACS being diagnosed in 5-10% of cases.<br /><br />Diagnostic evaluation of ACS includes biomarkers like troponin assays (TnI and TnT) and high-sensitivity troponin (hsTrp), favored for their diagnostic accuracy. Electrocardiography (EKG) is vital to detect active ischemia and infarction traces, such as T-wave inversions and ST-segment changes.<br /><br />ACS is categorized into unstable angina, NSTEMI, and STEMI, differentiated by EKG changes and biomarker presence. Reperfusion therapy via percutaneous coronary intervention (PCI) is essential within specific timeframes post-symptom onset, while thrombolysis is an option if PCI is delayed. Medical management involves antiplatelet agents (aspirin, P2Y12 inhibitors), anti-anginals (nitroglycerin, morphine), beta-blockers, and anticoagulants.<br /><br />For intermediate-risk patients, coronary CT angiography (CCTA) or stress testing may be utilized based on patient demographics and risk factors. The document emphasizes the importance of evaluating cardiac risk factors and thorough symptom characterization in diagnosing ACS and recommends the use of high-sensitivity troponin and EKG testing. <br /><br />Key references include the JAMA 2022 review by Bhatt et al. and the 2021 AHA/ACC guidelines by Gulati et al. The document serves as a guide for clinicians in assessing and treating ACS, incorporating the latest evidence-based practices.

Asset Subtitle

Jeffery Wagner

Keywords

Acute Coronary Syndrome

Coronary Artery Disease

Thrombus Formation

Troponin Assays

Electrocardiography

Reperfusion Therapy

Antiplatelet Agents

Coronary CT Angiography

High-Sensitivity Troponin

Evidence-Based Practices