acute%20coronary%20syndromes%20w_out%20persistent%20st-segment%20elevation
ACUTE CORONARY SYNDROMES W/OUT PERSISTENT ST-SEGMENT ELEVATION
Acute coronary syndromes refer to any constellation of clinical symptoms compatible with acute myocardial ischemia which may be life-threatening.
It encompasses unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).
Unstable angina is the ischemic discomfort that presents without persistent ST-segment elevation on ECG and without the presence of cardiac markers in the blood.
Non-ST-segment elevation myocardial infarction is diagnosed if cardiac markers are positive with ST-segment depression or with nonspecific or normal ECGs.
The patient typically presents with ischemic-type chest pain that is severe and prolonged and may occur at rest or may be caused by less exertion than previous episodes.

Monitoring

Further Testing

  • May be performed prior to discharge or as an outpatient
  • Stress test to provoke ischemia
    • Consider evaluation of left ventricle (LV) function if ischemia is present
    • If stress test is negative and history is still suggestive of ischemic pain, may consider nuclear scan, cardiac MRI or diagnostic coronary angiogram
    • If stress test is negative and history is not suggestive of ischemic pain, alternative diagnosis should be sought
  • Treadmill ECG, stress myocardial perfusion imaging, or stress echocardiography before discharge or within 72 hours after discharge is suggested in patients with possible ACS who have normal serial ECGs and cardiac troponins
  • Treat patient appropriately
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