chapter  Chapter 1
83 Pages

Acute Coronary Syndromes

ByKarim Ratib, Gurbir Bhatia, Neal Uren, James Nolan

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The term ‘acute coronary syndrome’ (ACS) has been developed to describe the collection of ischaemic conditions that include a spectrum of diagnoses from unstable angina to non-ST elevation myocardial infarction (NSTEMI) and STEMI. ACSs are caused by an imbalance between myocardial oxygen demand and supply that results in cell death and myocardial necrosis. The majority of patients with an ACS will have an abnormal electrocardiogram at some stage. The main aims for treatment of ACS are to prevent continued ischaemia, limit myocardial damage, reduce the incidence of left ventricular dysfunction, heart failure and death. Fundamental to the development of modern risk scores in non-ST elevation acute coronarysyndromes is the quantification of serum troponin. Successful treatment of ACS involves the use of potent antithrombotic regimens allied with percutaneous coronary intervention. Thrombocytopenia can occur after treatment for ACS as a result of exposure to heparins or GpIIb/IIIa inhibitors.