Clinical meaning
Acute coronary syndrome encompasses a spectrum from unstable angina to NSTEMI and STEMI, differentiated by the degree of coronary occlusion and resultant myocardial injury. In STEMI, complete thrombotic occlusion requires emergent reperfusion through PCI or fibrinolysis, while NSTEMI management involves risk stratification using TIMI or GRACE scores to determine timing of invasive strategy. Atrial fibrillation results from multiple re-entrant wavelets or focal triggers in the pulmonary veins, leading to atrial electrical disorganization and loss of coordinated atrial contraction, which increases thromboembolic risk proportional to CHA2DS2-VASc score. Heart failure exacerbations involve neurohormonal activation with increased RAAS and sympathetic tone causing sodium and water retention, elevated filling pressures, and end-organ hypoperfusion that requires careful hemodynamic-guided management.
Diagnosis & workup
Diagnostics & workup: - High-sensitivity troponin with serial measurements for ACS risk stratification - TIMI and GRACE scores for NSTEMI risk assessment and invasive strategy timing - CHA2DS2-VASc score for stroke risk stratification in atrial fibrillation - BNP or NT-proBNP for heart failure diagnosis and prognostication - Echocardiography for ejection fraction, valvular assessment, and hemodynamic parameters - sPESI score for PE risk stratification and outpatient management eligibility - CT pulmonary angiography with RV/LV ratio for submassive PE identification - Spirometry with bronchodilator reversibility for COPD staging per GOLD criteria - FeNO (fractional exhaled nitric oxide) for eosinophilic asthma phenotyping