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Chapter 7. Acute Coronary Syndromes

Phillip A Horwitz, MD;; Hjalti Gudmundsson, MD
DOI: 10.1378/critcare.21.7
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Sections

Objectives 
  • Understand the common pathophysiology in acute coronary syndrome subtypes.

  • Understand the role of early risk stratification and choice of management strategy in non-ST-elevation acute coronary syndromes.

  • Understand the indications and options for emergent reperfusion in ST-elevation myocardial infarction.

  • Review the mechanical complications of myocardial infarction.

  • Review the pharmacologic and lifestyle modifications to improve the long-term prognosis in acute coronary syndrome patients.

Synopsis 

Acute coronary syndrome (ACS) represents a spectrum of acute cardiac ischemic syndromes that include unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). They share the common pathophysiology of “vulnerable” atherosclerotic plaque rupture and subsequent thrombus formation. The management of STEMI centers on emergent coronary artery reperfusion with either fibrinolytic therapy or primary percutaneous coronary intervention. Anticoagulation strategies and risk stratification followed by appropriate use of coronary revascularization are the focus of management in UA and NSTEMI. All ACS patients need to have preventative treatments and lifestyle modifications instituted to prevent future adverse events.

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