ACUTE CORONARY SYNDROME :

FOCUS ON CHEST PAIN

MAGMA PURNAWAN PUTRA

KUPANG, OCTOBER 2022
 THE NUMBER

• AFTER INJURIES, CHEST PAIN IS THE SECOND MOST COMMON REASON FOR
ADULTS TO PRESENT TO THE EMERGENCY DEPARTMENT (ED) IN THE UNITED
STATES AND ACCOUNTS FOR >6.5 MILLION VISITS, WHICH IS 4.7% OF ALL ED
VISITS

• OF ALL ED PATIENTS WITH CHEST PAIN, ONLY 5.1% WILL HAVE AN ACUTE
CORONARY SYNDROME (ACS), AND MORE THAN HALF WILL ULTIMATELY BE
FOUND TO HAVE A NONCARDIAC CAUSE

• NONETHELESS, CHEST PAIN IS THE MOST COMMON SYMPTOM OF CAD IN

BOTH MEN AND WOMEN.

Gulati M, Levy P, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. J Am Coll Cardiol. 2021 Nov, 78 (22) e187–e285.
 ACS LIKELIHOOD

Marco Roffi, Carlo Patrono, Jean-Philippe Collet, et. al., ESC Scientific Document Group, 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary
Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC),  European Heart Journal, Volume 37, Issue 3, 14 January 2016, Pages 267–315
 THE CHARACTERISTICS AND CORRESPONDING CAUSES

Gulati M, Levy P, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. J Am Coll Cardiol. 2021 Nov, 78 (22) e187–e285.
DIFFERENTIAL
DIAGNOSES
 PHYSICAL EXAMINATION

Gulati M, Levy P, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. J Am Coll Cardiol. 2021 Nov, 78 (22) e187–e285.
GENERAL APPROACH TO RISK STRATIFICATION OF
PATIENTS WITH SUSPECTED ACS

Gulati M, Levy P, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and
Diagnosis of Chest Pain. J Am Coll Cardiol. 2021 Nov, 78 (22) e187–e285.
Jean-Philippe Collet, Holger Thiele, Emanuele Barbato, et.al., ESC Scientific Document Group, 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary
syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC),  European Heart Journal, Volume 42, Issue 14, 7 April 2021, Pages 1289–1367
Borja Ibanez, Stefan James, Stefan Agewall, et. al., ESC Scientific Document Group, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients
presenting with ST-segment elevation of the European Society of Cardiology (ESC), European Heart Journal, Volume 39, Issue 2, 07 January 2018, Pages 119–177