Diagnosing 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 likelythan 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.

In addition, imaging studies used in ACS for riskstratification and treatment planning include
Echocardiography to assess ventricular functionCoronary angiography, the current gold standard for visualising coronary artery lesions (and for revascularisation by balloon angioplasty with stent placement)
CT angiography
MR angiography