Diagnosis and management of acute coronary syndrome: an evidence-based update.
Acute coronary syndrome (ACS) describes the range of myocardial ischemic states that includes unstable angina, non-ST elevated myocardial infarction (MI), or ST-elevated MI. ACS is associated with substantial morbidity and mortality and places a large financial burden on the health care system. The diagnosis of ACS begins with a thorough clinical assessment of a patient's presenting symptoms, electrocardiogram, and cardiac troponin levels as well as a review of past medical history. Early risk stratification can assist clinicians in determining whether an early invasive management strategy or an initial conservative strategy should be pursued and can help determine appropriate pharmacologic therapies. Key components in the management of ACS include coronary revascularization when indicated; prompt initiation of dual antiplatelet therapy and anticoagulation; and consideration of adjuvant agents including β blockers, inhibitors of the renin angiotensin system, and HmG-coenzyme A reductase inhibitors. It is essential for clinicians to take an individualized approach to treatment and consider long-term safety and efficacy when managing patients with a history of ACS after hospital discharge.
From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC (JNS, JMN, EMH); Department of Family Medicine, Guthrie/Robert Packer Hospital, Sayre, PA (MBM); Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC (EMH, AJV) j.smith@usciences.edu.
Jennifer N
JN
Smith
From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC (JNS, JMN, EMH); Department of Family Medicine, Guthrie/Robert Packer Hospital, Sayre, PA (MBM); Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC (EMH, AJV).
Jenna M
JM
Negrelli
From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC (JNS, JMN, EMH); Department of Family Medicine, Guthrie/Robert Packer Hospital, Sayre, PA (MBM); Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC (EMH, AJV).
Megha B
MB
Manek
From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC (JNS, JMN, EMH); Department of Family Medicine, Guthrie/Robert Packer Hospital, Sayre, PA (MBM); Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC (EMH, AJV).
Emily M
EM
Hawes
From the Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC (JNS, JMN, EMH); Department of Family Medicine, Guthrie/Robert Packer Hospital, Sayre, PA (MBM); Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC (EMH, AJV).
Anthony J
AJ
Viera
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans
Acute Coronary Syndrome; Cardiology; Myocardial Infarction