The clinics of acute coronary syndrome

Abstract

Risk stratification and management of patients with chest pain continues to be challenging despite considerable efforts made in the last decades by many clinicians and researchers. The throutful evaluation necessitates that the physicians have a high index of suspicion for acute coronary syndrome (ACS) and always keep in mind the myriad of often subtle and atypical presentations of ischemic heart disease, especially in certain patient populations such as the elderly ones. In this article we aim to review and discuss the available evidence on the value of clinical presentation in patients with a suspected ACS, with special emphasis on history, characteristics of chest pain, associated symptoms, atypical presentations, precipitating and relieving factors, drugs, clinical rules and significance of clinical Gestalt.

Keywords: Chest pain; NSTEMI; ST elevation MI (STEMI); acute coronary syndrome (ACS); myocardial infarction (MI); unstable angina (UA).

Figure 1

Schematical representation of the so-called “typical” (red) and “atypical” (green) localizations of chest pain.