title: Diagnosis of acute coronary syndrome.
abstract: The term "acute coronary syndrome" encompasses a range of thrombotic coronary artery diseases, including unstable angina and both ST-segment elevation and non-ST-segment elevation myocardial infarction. Diagnosis requires an electrocardiogram and a careful review for signs and symptoms of cardiac ischemia. In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation or depression (including J-point elevation in multiple leads), and pathologic Q waves. Risk stratification allows appropriate referral of patients to a chest pain center or emergency department, where cardiac enzyme levels can be assessed. Most high-risk patients should be hospitalized. Intermediate-risk patients should undergo a structured evaluation, often in a chest pain unit. Many low-risk patients can be discharged with appropriate follow-up. Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. Early markers of acute ischemia include myoglobin and creatine kinase-MB subforms (or isoforms), when available. In the future, advanced diagnostic modalities, such as myocardial perfusion imaging, may have a role in reducing unnecessary hospitalizations.
authors.affiliation: University of California, San Diego, School of Medicine, La Jolla, California 92037-0968, USA. sachar@ucsd.edu
authors.forename: Suraj A
authors.initials: SA
authors.lastname: Achar
authors.forename: Suriti
authors.initials: S
authors.lastname: Kundu
authors.forename: William A
authors.initials: WA
authors.lastname: Norcross
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D000789:Angina, Unstable / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D003663:Decision Trees; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D016013:Likelihood Functions; D008487:Medical History Taking; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D009211:Myoglobin / Q000097:blood; D010343:Patient Admission; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013577:Syndrome; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D019210:Troponin I; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form