Acute Coronary Syndromes
Key words: ACS, myocardial infarction, MI, myocardial ischaemia, angina
Acute coronary syndrome (ACS) is a clinical syndrome that includes a heterogeneous group of patients with symptoms typical of acute myocardial ischemia, but without the traditional evidence on an electrocardiogram (ECG) of ST-segment elevation myocardial infarction (STEMI) [e.g. image below].
Electrocardiogram (ECG) of ST-segment elevation myocardial infarction:
Within the clinical diagnosis of ACS, the difference between unstable angina (UA) and non-ST elevation myocardial Infarction (NSTEMI) is determined by the presence of positive biomarkers (myocardial creatine kinase methyl bromide (CK-MB) isoenzyme , and cardiac troponins). Initial diagnosis of ACS is based on patient history, risk factors and to a lesser extent ECG findings [chart].
Guidelines from the Heart Foundation and Cardiac Society of Australia and New Zealand make the following recommendations for acute management of chest pain:
- People experiencing symptoms of an ACS should seek help promptly from emergency medical services.
- The most important initial need is access to a defibrillator to avoid early cardiac death from reversible arrhythmias.
- Aspirin should be given early (ie, by emergency or ambulance personnel) unless already taken or contraindicated.
- Oxygen should be given, as well as glyceryl trinitrate and intravenous morphine as required.
- Where appropriate, a 12-lead electrocardiogram (ECG) should be taken en route and transmitted to a medical facility.
- Where formal protocols are in place, pre-hospital treatment (including fibrinolysis in appropriate cases) should be facilitated.
- lectrocardiogram infarction
Guidelines and clinical resources
- Australian Guidelines for the Management of Acute Coronary Syndrome from the Heart Foundation and the Cardiac Society of Australia and New Zealand (2006) These guidelines were developed by means of a consensus approach which involved an independent assessment of key Australian and international evidence-based clinical guidelines, scientific articles and trial data…
- Guidelines for the Management of Acute Coronary Syndromes – summary of key recommendations from the Heart Foundation It is important to establish an initial working diagnosis to guide clinical decision making…
- Guidelines for the Management of Acute Coronary Syndromes – slide presentation (pdf) This presentation is adapted with permission from the National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand 'Guidelines for the management of acute coronary syndromes 2006'…
- Addendum to the Australian Guidelines for the Management of Acute Coronary Syndrome (2007) This addendum supplements the recommendations outlined in the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand "Guidelines for the management of acute coronary syndromes 2006". Results from recently published clinical trials provide additional information…
- Summary report from the National Acute Coronary Syndromes Implementation Forum (2007) The objective of this forum was to gain consensus from experts and key opinion leaders on priority intervention points to improve the management of acute coronary syndromes in Australia…
- ACS therapy algorithm from the Heart Foundation (2006) Emergency Department/CCU Guidelines for the Management of Acute Coronary Syndromes…
- Recommended Framework for Cardiac Rehabilitation from the Heart Foundation and Australian Cardiac Rehabilitation Association (2004) This document updates the recommendations for cardiac rehabilitation prepared by the National Cardiac Rehabilitation Advisory Committee of the National Heart Foundation of Australia in 1998. It represents the current recommendations for cardiac rehabilitation throughout Australia…
- MD Consult ACS Overview covering diagnosis, treatment, outcomes and prevention in acute coronary syndromes The ACS includes unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI)…
- medbrains.net: Acute coronary syndromes, Part I – Epidemiology Overview of an evidence-based approach to ACS.
- medbrains.net: Acute coronary syndromes, Part II – Emergency department/early management STEMI or NSTEACS Overview of an evidence-based approach to ACS.
- medbrains.net: Acute coronary syndromes, Part III – Risk stratification of patients with suspected AMI Overview of an evidence-based approach to ACS.
