Clinical meaning
Acute coronary syndrome encompasses unstable angina, NSTEMI, and STEMI. Vulnerable atherosclerotic plaque ruptures, exposing the thrombogenic lipid core to circulating blood. Platelet adhesion and activation trigger the coagulation cascade, forming a thrombus that partially (NSTEMI) or completely (STEMI) occludes the coronary artery.
Diagnosis & workup
Diagnostics & workup: - Order serial troponin (high-sensitivity preferred) at 0 and 3 hours - Order 12-lead ECG within 10 minutes of presentation - Order echocardiogram to assess wall motion abnormalities - Order lipid panel and HbA1c - Order coronary angiography for STEMI or high-risk NSTEMI - Order BNP if heart failure suspected
Risk factors: - Known CAD or prior MI - Hypertension and hyperlipidemia - Diabetes mellitus - Active smoking - Family history of premature CAD (<55 male, <65 female) - Cocaine or methamphetamine use - Chronic kidney disease