alexa Acute coronary syndrome | France | PDF | PPT| Case Reports | Symptoms | Treatment

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Acute Coronary Syndrome

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  • Acute coronary syndrome

     Acute coronary syndrome is a term used for any condition brought on by sudden, reduced blood flow to the heart. Acute coronary syndrome symptoms may include the type of chest pressure that you feel during a heart attack, or pressure in your chest while you're at rest or doing light physical activity (unstable angina).

    Typical symptoms

    • Chest pain (angina) that feels like burning, pressure or tightness

    • Pain elsewhere in the body, such as the left upper arm or jaw (referred pain)

    • Nausea

    • Vomiting

    • Shortness of breath (dyspnea)

    • Sudden, heavy sweating (diaphoresis)

    The signs and symptoms may vary depending on your sex, age and whether you have an underlying medical condition, such as diabetes, heart attack.

    Some additional heart attack symptoms include:

    • Abdominal pain

    • Pain similar to heartburn

    • Clammy skin

    • Lightheadedness, dizziness or fainting

    • Unusual or unexplained fatigue

    • Feeling restless or apprehensive

    Causes

    • Acute coronary syndrome is most often a complication of plaque buildup in the arteries in heart

    • Blood clots in blood streams (embolism)

    • Cigarette smoking

    • Lack of physical activity

    • Type 2 diabetes

    • High blood pressure

    • High blood cholesterol

  • Acute coronary syndrome

     Tests and diagnosis

    Electrocardiogram (ECG)

    This is the first test done to diagnose a heart attack. It's often done while you're being asked questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.

    Blood tests

    Certain heart enzymes slowly leak into your blood if your heart has been damaged by a heart attack. Emergency room staff will take samples of your blood to test for the presence of these enzymes.

    Echocardiogram

    If your doctor decides you haven't had a heart attack and your risk of having a heart attack is low, you'll likely have an echocardiogram before you leave the hospital. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest.

    Chest X-ray

    An X-ray image of your chest allows your doctor to check the size and shape of heart and its blood vessels.

    Nuclear scan

    This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it is taken up by heart muscle.

    Coronary angiogram (cardiac catheterization)

    Computerized tomography (CT) angiogram

    Exercise stress test

    Treatments and Drugs

    Medications include

    • Aspirin

    • Thrombolytics

    • Nitroglycerin

    • Beta blockers

    • Angiotensin-converting enzyme (ACE) inhibitors

    • Angiotensin receptor blockers (ARBs)

    • Calcium channel blockers

    • Cholesterol-lowering drugs

    • Clot-preventing drugs

    Surgery and other procedures

    • Angioplasty and stenting

    • Coronary bypass surgery

  • Acute coronary syndrome

     Statistics

    A Population-based longitudinal cohort conducted in France,and other European countries are comprising 12 231 consecutive ACS patients admitted in 53 hospitals between 2008 and 2010. Baseline characteristics, clinical management and inhospital outcomes were recorded. Contextual effect of country on death was analysed through multilevel analysis.

    Of all patients included, 8221 (67.2%) had NSTEMI (non-ST-elevation myocardial infarction), and 4010 (32.8%) had STEMI (ST-elevation myocardial infarction). Inhospital mortality ranged from 15.1% to 4.9% for German and Spanish STEMI patients, and from 6.8% to 1.9% for Finnish and French NSTEMI patients (p<0.001 for both).

    These international variations were explained by differences in patients' baseline characteristics (older patients more likely to have cardiogenic shock in Germany) and in clinical management, with differences in rates of thrombolysis (less performed in Germany) and primary percutaneous coronary intervention (high in Germany, low in Greece).

    A remaining contextual effect of country was identified after extensive adjustment.

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