ACUTE CORONARY
SYNDROMES
FIRST PART: CLASSIFICATION, PATHOPHISIOLOGY
AND DIAGNOSIS
Acute coronary syndromes represent a continuum of acute
myocardial ischemia, which includes acute transmural myocardial infarction with
ST segment elevation, myocardial infarction without ST segment elevation, and
unstable angina pectoris. The acute coronary syndromes are a common cause for an
urgent hospital admission and also a major burden on health care resources in
industrialized countries today.
In practice, two categories of patients may be encountered.
Patients with chest pain and persistent ST segment elevation (or LBBB) and
patients with chest discomfort with ECG abnormalities without ST segment
elevation, but ST segment depression, or T wave inversion, flat or
pseudo-normalization, or nonspecific ECG changes or normal ECG.
Acute coronary syndromes are the consequence of an acute or sub-acute primary
reduction of myocardial oxygen supply provoked by disruption of an
atherosclerotic plaque associated with inflammation, thrombosis,
vasoconstriction and microembolization.
The traditional approach to the assessment of patients with
suspected acute coronary syndrome is based on three criteria: assessment of
clinical symptoms, electrocariographic findings on admission electrocardiogram
and measurements of biochemical markers. Acta Medica Medianae 2005; 44(1):
31-37.
Key words: unstable angina, myocardial infarction,
biochemical markers