Acute coronary syndromes diagnosis

Patients with ischemic chest discomfort and suspected acute coronary syndrome are risk-stratified based upon a 12-lead electrocardiogram, past medical history, and results of the creatine kinase myocardial band and troponin tests. The diagnosis... 

Achar SA, Kundu S, Norcross WA. Diagnosis of acute coronary syndrome. Am Fam Physician. 2005 72 119-126. 

Storrow AB, Gibler WB. Chest pain centers Diagnosis of acute coronary syndromes. Ann Emerg Med 2000 35 449-461. 

Sinha MK, Roy D, Gaze D, Collinson PO, Kaski JC. Role of ischemia modified albumin, a new biochemical marker of myocardial ischemia, in the early diagnosis of acute coronary syndromes. Emerg Med J 2004 21 29-34. 

Jaffe AS, Davidenko J, Clements I. Diagnosis of acute coronary syndromes including myocardial infarction. In Crawford MH, DiMarco JP, Paulus WJ, eds. Cardiology. 2nd ed. St Louis Mosby 2004 311-28. 

Figure 8.2 Acute coronary syndromes ECG abnormalities at admission and diagnosis at discharge.

Roig S, Gomez S, Fiol M et al. Spontaneous coronary artery dissection causing acute coronary syndrome an early diagnosis implies a good prognosis. Am J Emerg Med 2003 29 549. 

Wagner GS, Limb T, Gorgels A et al. Consideration of pitfalls in the current ECG standards for diagnosis of myocardial ischemia/infarction in patients who have acute coronary syndrome. Cardiol Clin 2007. In press. 

Cardiovascular Among 82717 US veterans with a new diagnosis of COPD, who were followed until they had their first hospitalization for a cardiovascular event, or died, or reached the end of the study period, there were 6234 cardiovascular events (44% heart failure, 28% acute coronary syndrome, and 28% cardiac dysrhythmias) [27. The risk of cardiovascular events was increased in those who had used ipratropium in the past 6 months (HR=1.40 95% Cl = 1.3, 1.5). Among those who had used an anticholinergic drug more than 6 months before, there did not appear to be an increased risk of a cardiovascular event. This study was limited, owing to incomplete hospital admission data and lack of data on cardiovascular risk factors and severity of COPD. 

Cardiovascular A 64-year-old woman treated for macular degeneration with intraocular injections of bevacizumab presented with chest pain, nausea and vomiting. After an initial diagnosis of acute coronary syndrome and anticoagulation treatment with intravenous heparin, she remained stable without chest pain or shortness of breath and with no evidence of arrhythmias. This may be the first report of an association between intraocular bevacizumab and reversible myocardial dysfunction with a pattern similar to stress-induced cardiomyopathy (also called Takotsubo cardiomyopathy or apical ballooning), although clear evidence for a causal relationship is lacking [97 ]. 

Serum biomarkers of acute coronary syndrome play a critical role in the diagnosis and risk stratification of patients with ACS. Myocardial necrosis observed in patients with ACS releases a variety of proteins into blood that can be used as biomarkers. Antiquated markers include aspartate aminotransferase, lactate dehydrogenase (LD) and its isoenzyme (LDl), myoglobin, and creatine kinase (CK) and its isoenzyme (CK-MB). While some of these markers are still in routine use, there is consensus among experts in the field of cardiology, emergency medicine, and laboratory medicine that cardiac troponin is the gold standard marker for ACS. 

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