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Review
. 2016 Dec;16(Suppl 6):s43-s48.
doi: 10.7861/clinmedicine.16-6-s43.

Acute coronary syndromes

Tushar Kotecha  1 , Roby D Rakhit  1
Affiliations
Review

Acute coronary syndromes

Tushar Kotecha et al. Clin Med (Lond). 2016 Dec.

Abstract

In the UK, there are over 80,000 admissions annually with acute coronary syndromes (ACS). Management of ST-elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PCI), which is delivered via dedicated heart attack centres. Non-ST elevation-ACS (NSTE-ACS) accounts for two-thirds of ACS presentations, affecting an older cohort of patients - often with more complex comorbidities. Initial management is with anti-thrombotic therapy with a view to PCI within 24 hours for the most acute cases and within 72 hours for all others. However, varying management pathways and access to specialist cardiology services results in variable times to definitive treatment. Advances in the sensitivity of cardiac biomarkers and the use of risk assessment tools now enable rapid diagnosis within a few hours of symptom onset. Advances in invasive management and drug therapy have resulted in improved clinical outcomes with resultant decline in mortality associated with ACS.

Keywords: Acute coronary syndrome; ST-elevation myocardial infarction; non-ST elevation acute coronary syndrome; non-ST elevation ­myocardial infarction.

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Figures

Fig 1.
Fig 1.
Example of 12-lead electrocardiogram showing ST-segment elevation in the inferior leads (II, III and aVF) with reciprocal ST-segment depression in leads V1–V4, I and aVL.
Fig 2.
Fig 2.
Coronary angiogram of patient presenting with inferior ST-elevation myocardial infarction. A – occluded right coronary artery (arrow); B – successful restoration flow ­following implantation of a drug-eluted stent.
Fig 3.
Fig 3.
Example of 12-lead electrocardiogram showing antero-lateral T wave inversion (leads V2–V6, I and aVL) consistent with non-ST elevation-acute coronary syndrome.
Fig 4.
Fig 4.
Coronary angiogram of a patient presenting with non-ST elevation-acute coronary syndrome. Electrocardiogram showed anterior T wave inversion. A – critical stenosis in proximal left anterior descending artery (arrow); B – successful restoration of flow following implantation of a drug-eluted stent.
See this image and copyright information in PMC

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