[Features and pathophysiology of acute coronary syndrome]
Mijo Bergovec1, Hrvoje Vrazić, Ivana Rajcan Spoljarić
1Department of Cardiovascular Diseases, University Department of Medicine, Dubrava University Hospital, Zagreb, Croatia. mijo.bergovec@usa.net
Insights
Coronary heart disease (CHD) is a leading cause of death globally. Acute coronary syndromes (ACS), including unstable angina and myocardial infarction, are classified by ST segment elevation and cardiac biomarker levels, reflecting disease severity.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- Coronary heart disease (CHD) presents a significant global health burden, being the primary cause of mortality in developed nations and rapidly increasing in developing countries.
- Acute coronary syndromes (ACS) represent a spectrum of conditions arising from coronary artery disease, necessitating precise classification for effective management.
Purpose:
- To elucidate the classification and diagnostic criteria for acute coronary syndromes (ACS), differentiating between ST-segment elevation myocardial infarction (STEMI) and ACS without ST-segment elevation (NSTEMI, UA).
- To highlight the underlying pathophysiology of ACS, emphasizing the roles of atherosclerosis, plaque rupture, and thrombosis.
Summary:
- ACS are categorized based on ST-segment elevation and cardiac biomarker levels, distinguishing STEMI from non-ST-elevation ACS (NSTEMI and unstable angina, UA).
- UA is characterized by ischemic chest pain without elevated cardiac biomarkers, whereas NSTEMI diagnosis requires biomarker elevation.
- STEMI involves both ST-segment elevation and elevated cardiac biomarkers, indicating significant myocardial damage.
Impact:
- Understanding these distinctions is crucial for tailoring treatment strategies and improving patient outcomes in acute cardiovascular events.
- The severity of myocardial ischemia, indicated by cardiac biomarker release, is a key determinant in differentiating ACS subtypes and guiding therapeutic interventions.
Abstract:
Coronary heart disease (CHD) is the leading cause of death in developed countries, and it also has fastest growing death rates in developing countries. Patients with acute coronary syndromes (ACS) are divided into two groups - those with and those without ST segment elevation. ACS without ST segment elevation also includes unstable angina pectoris (UA) any non-ST elevation myocardial infarction (NSTEMI). It is important to note that UA is defined as ischemic chest pain at rest without a rise in serum cardiac biomarkers, while the establishment of NSTEMI diagnosis requires a rise in serum cardiac biomarkers. ACS with ST segment elevation is STEMI, and it includes both ST segment elevation and a rise in serum cardiac biomarkers. Connection of UA, NSTEMI and STEMI is based on the fact that these are closely connected conditions with similar pathogenesis and clinical presentation, but they do differ by the level of severity. The main difference lies in the fact whether or not the ischemia is serious enough to cause myocardial damage of such an extent that will cause the release of a sufficient amount of serum cardiac biomarkers so that these can be discovered and measured in serum (for example, cardiac troponin). The key role in ACS is played by atherosclerosis, atherosclerotic plaque and plaque rupture, in combination with thrombosis as an event of paramount importance--thrombosis.
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