Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update

Abstract

Acute coronary syndrome (ACS) describes the range of myocardial ischemic states that includes unstable angina, non-ST elevated myocardial infarction (MI), or ST-elevated MI. ACS is associated with substantial morbidity and mortality and places a large financial burden on the health care system. The diagnosis of ACS begins with a thorough clinical assessment of a patient's presenting symptoms, electrocardiogram, and cardiac troponin levels as well as a review of past medical history. Early risk stratification can assist clinicians in determining whether an early invasive management strategy or an initial conservative strategy should be pursued and can help determine appropriate pharmacologic therapies. Key components in the management of ACS include coronary revascularization when indicated; prompt initiation of dual antiplatelet therapy and anticoagulation; and consideration of adjuvant agents including ␤ blockers, inhibitors of the renin angiotensin system, and HmG-coenzyme A reductase inhibitors. It is essential for clinicians to take an individualized approach to treatment and consider long-term safety and efficacy when managing patients with a history of ACS after hospital discharge. The term myocardial infarction (MI) is used when there is evidence of myocardial necrosis in the setting of acute myocardial ischemia. STEMI is differentiated from NSTEMI by the presence of persistent ECG findings of ST segment elevation. 3In recent years, progress has been made in the management of ACS, particularly related to optimizing pharmacotherapy. 2,3 Family physicians care for patients presenting with ACS in office as well as emergency settings and play an important role in both acute and long-term management of such patients. In this article, we review the topic of ACS with particular emphasis on initial management and use of the newer medications. Specific coronary interventions performed by the cardiologist (eg, stents or balloon angioplasty) are beyond the scope of this review. Scope of the ProblemCoronary heart disease (CHD) is responsible for more than half of all cardiovascular events in individuals less than 75 years of age. The prevalence of This article was externally peer reviewed.

Apelin: an antithrombotic factor that inhibits platelet function

“…Expression of apelin and APJ receptor in human and mouse platelets: role in platelet aggregation Altered platelet function [1][2][3] and apelin levels 4,[11][12][13][14] are associated with various cardiovascular diseases. Therefore, we investigated whether apelin could act on platelet function.…”

“…However, platelet aggregation also contributes to thrombotic events, causing acute coronary syndrome, heart attacks, and strokes. [1][2][3] After vessel injury, the exposed subendothelial surface induces platelet adhesion. Platelet activation and secretion of soluble mediators, such as adenosine 59-diphosphate (ADP), thromboxane A 2 (TXA 2 ), and thrombin, are all involved in the recruitment of other circulating platelets.…”

A study of drug utilization trends in acute coronary syndrome in intensive cardiac care unit at a tertiary care hospital, Mysore

“…[9][10][11] It was said in a study that there has been a substantial reduction in the incidence of STEMI and a subsequent increase in the incidence of NSTEMI. 12 The exact reason for this changing trend is not known. But this can be probably due to improved treatment strategies for STEMI.…”

Caracterização do perfil e complicações intra-hospitalares dos pacientes submetidos ao cateterismo cardíaco em um hospital terciário

“…Em 2014, foram registrados 87.234 óbitos no Brasil relacionados à SCA [15]. Apesar da melhora na sobrevida associada a essa condição, ainda continua a ter associação importante com desfechos fatais e grande impacto no sistema de saúde [16].…”