Description
Acute coronary syndrome (ACS) is the term for the clinical signs and symptoms of myocardial ischemia: unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Unstable angina and NSTEMI normally result from a partially or intermittently occluded coronary artery, whereas STEMI results from a fully occluded coronary artery. The patients present with a wide arena of signs and symptoms like chest pain, nausea/vomiting, exertional pain, palpitation, shortness of breath, fatigue, etc. Angina, or chest pain, continues to be recognized as the classic symptom of ACS. In unstable angina, chest pain normally occurs either at rest or with exertion and results in limited activity. Chest pain associated with NSTEMI is usually longer in duration and more severe than chest pain associated with unstable angina. The diagnosis of ACS is based on triad of clinical presentation, electrocardiography and cardiac biomarkers. Electrocardiography is the most important initial diagnostic procedure when doctors suspect an acute coronary syndrome. Findings on a 12-lead ECG help the practitioner to differentiate between myocardial ischemia, injury, and infarction, locate the affected area and assess related conduction abnormalities. But at the same front, the definition of unstable angina, NSTEMI and STEMI is based on the levels of cardiac biomarkers too. Acute coronary syndromes are medical emergencies that need prompt action. Half
Chapter
Biomarkers: Past, Present and Future
Aims of Biomarker Use, Required Accuracy, and Acceptable Risk
The History of Cardiac Biomarkers in Acute Coronary Syndrome
Serum Glutamate Oxaloacetate Transaminase (SGOT) or Aspartate Aminotransferase (AST)
Time Course of Myocardial Enzyme Elevations in Serum Following Infarction
Elevations of Troponin in the Absence of Overt Ischemic Heart Disease
Elevations of Troponin in the Absence of Overt Ischemic Heart Disease
The Current Biochemical Definition of Myocardial Infarction
Current Biomarkers in Clinical Use
Important Values to Know About Troponin Assays
Brain Natriuretic Peptide and NT-pro-BNP
Best Practice in the Use of Current Cardiac Biomarkers
Single Marker Approach Based upon Troponin
Multi-Marker Approach Based Upon Troponin Plus
One or More Other Markers
Recommendations for Cardiac Biomarker Use in Suspected Acs
The Use of Point of Care Testing
Risk Stratification and Pre-Test Probability
Required Characteristics of the Perfect Biomarker for Acute Coronary Syndrome
Criteria for Assessment of Novel Cardiovascular Biomarkers for Clinical Use
Pregnancy-associated Plasma Protein A (PaPP-A)
Placental Growth Factor (PlGF)
Ischemia Modified Albumin (IMA)
Fatty Acid Binding Protein
Thrombolysis Versus Primary Percutaneous Intervention in ST-Elevation Myocardial Infarction: Evidence Versus Clinical Practice
History of Evolution of Treatment of Acute Myocardial Infarction
Modality of Choice for Symptom Duration of 3 Hours
Are Benefits of PPCI Less Time Dependent?
Elderly with Acute STEMI Patients
Pre-hospital Thrombolysis Versus PPCI
Practical Guide to Treatment of Acute Stemi
Emergency Medical System and Triage
Time Duration for Reperfusion Therapy
Selection of Reperfusion Therapy
Pharmacological Management
Post-thrombolysis Angiography
Fibrinolysis-facilitated PCI (PCI after Fibrinolysis)
Percutaneous Coronary Interventions in Acute Coronary Syndrome: Bare-Metal Stents or Drug-Eluting Stents-What Does the Evidence Say?
BMS vs DES in Acute Coronary Syndrome (Acute STEMI)
Impact of Diabetes and Acute Coronary Syndrome on Survival in Patients Treated with Drug-eluting Stents
DES or BMS in St-Elevation Acs: Indian Data
Personal Clinical Management
Case Studies Percutaneous Coronary Interventions in Acute Coronary Syndrome: Bare-Metal Stents or Drug-Eluting Stents-What ...
Issue: Which Patient Should (Can) Receive BMS During Stemi PCI?
Issue: Which Patient should Receive a Des?
Issue: Is there any Patient Who Should not be Given a Stent?
Role of Antiplatelets in Management of Unstable Angina and Non-ST-Elevation Myocardial Infarction
Platelets in Unstable Angina/Nstemi
Antiplatelets in Usa/Nstemi
Adenosine Diphosphate (ADP) Receptor Antagonists
Clopidogrel in Acute Coronary Syndrome
Clopidogrel in Percutaneous Coronary Intervention
Timing of Initiation of Clopidogrel Therapy in ACS: before or after Coronary Angiography (CAG)?
Importance of Clopidogrel Loading Dose
Dose Effect of Clopidogrel Reloading in Patients Already on 75-mg Maintenance Dose?
Ideal Daily Maintenance Dose - 75mg or 150mg?
Dual Antiplatelet Drug Resistance in Patients with Acute Coronary Syndrome
Platelet Aggregation Studies to Regulate Dose
ACC/AHA Class I Recommendations for Use of Long Term Antiplatelet Therapy in UA/NSTEMI41
Meta-analysis of Gp IIb/IIIa Inhibitors
Concomitant Use of Gp IIb/IIIa Inhibitors with Clopidogrel
Concomitant Use of Gp IIb/IIIa Inhibitors with Heparin
Gp IIb/IIIa Inhibitors vs Bivalirudin
Early ACS - Delay Gp IIb/IIIa Inhibitors until in Cath Lab57?
Gp IIb/IIIa Inhibition: Can We Cut the Infusion?
ACC/AHA Recommendations for Use of Gp IIb/IIIa Inhibitors in ACS41
Acc/Aha Class I Recommendations for Antiplatelet Therapy and Cabg41
Antiplatelets and Proton Pump Inhibitors
Controversies in Use of Anticoagulants in Management of Acute Coronary Syndrome
Classification of Anticoagulants
Anticoagulant Therapy in Nstemi/ Ua: Indirect Thrombin Inhibitors
Low Molecular Weight Heparin
Direct Thrombin Inhibitors
Oral Anticoagulation in Ua/Nstemi
Anticoagulation Therapy in Stemi
Low Molecular Weight Heparin
Post Myocardial Infarction Risk Stratification: A Multifactorial Strategy
Risk Stratification in Stemi
Laboratory Investigations
Hospital Phase of Risk Assessment
Monitoring for Hemodynamic Instability
Pre-discharge Risk Assessment
Assessment of Myocardial Ischemia
Assessment of Electrical Instability
Case Studies Post Myocardial Infarction Risk Stratification: A Multifactorial Strategy
ECAB Clinical Update: Cardiology
Follow-Up After Cardiovascular Surgery
Acute Coronary Syndrome - ECAB
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