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ACUTE CORONARY

SINDROME

I KETUT SUSILA
2014 AHA/ACC Guideline for the Management of
Patients With NonST-Elevation Acute Coronary
Syndromes
2015 ESC guidelines for the
management of acute coronary
syndromes

Definitions
Patients with acute chest pain and persistent (.20 min) ST-segment elevation.

This condition is termed ST-elevation ACS and generally re- flects an acute

total coronary occlusion. Most patients will ultim- ately develop an ST-

elevation myocardial infarction (STEMI)

Patients with acute chest pain but no persistent ST-segment elevation.

ECG changes may include transient ST-segment elevation, persistent or transient


ST-

segment depression, T-wave inver- sion, flat T waves or pseudo-normalization of T


waves or

the ECG may be normal. The clinical spectrum of non-ST-elevation ACS (NSTE-ACS)
Diagnosis

Clinical presentation
Anginal pain in NSTE-ACS patients may have the following
presentations:
- Prolonged (.20 min) anginal pain at rest;
- New onset (de novo) angina (class II or III of the Canadian Car-
diovascular Society classification)
- Recent destabilization of previously stable angina with at least
Canadian Cardiovascular Society Class III angina characteristics
(crescendo angina); or
- Post-MI angina.
Universal definition of myocardial
infarction
Diagnostic tools
Atypical ECG presentations that deserve prompt management
in patients with signs and symptoms of ongoing myocardial
ischaemia
Differential diagnoses of acute coronary
syndromes in the setting of acute chest
pain
Risk criteria mandating invasive strategy in
NSTE-ACS
Recommendations for relief of pain,
breathlessness and anxiety
Dosing of anticoagulants in patients with
normal and impaired renal function
Recommended unit and duration of
monitoring according to clinical presentation
after established NSTE-ACS diagnosis
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Chief Investment Strategist
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200 Sandy Springs Place, Suite
300
Atlanta, GA 30328
404-531-0018
www.yourwealth.com