Acute coronary syndrome

Question 1

What is acute coronary syndrome?

Answer 1

acute myocardial ischemia and/or infarction due to partial or complete occlusion of a coronary artery

Question 2

What are the clinical features of acute coronary syndrome?

Answer 2

Angina at rest or with minimal exertion
New-onset angina
Severe, persistent, and/or worsening angina (crescendo angina)
Autonomic symptoms may be present: diaphoresis, syncope, palpitations, nausea, and/or vomiting

Question 3

What are the cardiac biomarkers for acute coronary syndrome?

Answer 3

(Unstable) None
(NSTEMI) Elevated cardiac biomarkers (e.g., troponin)
(STEMI) Elevated cardiac biomarkers (e.g., troponin)

Question 4

What are the ECG changes in acute coronary syndrome?

Answer 4

(Unstable) Normal
(NSTEMI) Normal or nonspecific (e.g., ST depression, loss of R wave, or T-wave inversion)
(STEMI) ST elevations (in two contiguous leads) or new left bundle branch block

Question 5

What are the risk factors of acute coronary syndrome?

Answer 5

Atherosclerosis
Age
Male gender
Family history

Question 6

What are the causes of acute coronary syndrome?

Answer 6

Atherosclerosis
Coronary artery vasospasm
Coronary artery dissection

Question 7

How is acute coronary syndrome diagnosed?

Answer 7

ECG
Cardiac biomarkers (i.e. troponin, CK-MB)
Coronary angiography

Question 8

What is the treatment for acute coronary syndrome

Answer 8

All patients
(Meds) Sublingual or intravenous nitrate (nitroglycerin, for pain) , Beta blocker, Statins (lipid control), Loop diuretic (e.g., furosemide, for heart failure), Supportive care
STEMI
(Immediate revascularization) Emergency coronary angiography, Thrombolytic therapy, Coronary bypass graft
(Meds) Dual antiplatelet therapy (Aspirin + rasugrel, ticagrelor, or clopidogrel )
Anticoagulation (i.e. heparin)
Unstable angina or NSTEMI
Dual antiplatelet therapy, anticoagulation, immediate / delayed vascularization