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Continuing Education in Anaesthesia, Critical Care & Pain 2004 4(6):175-180; doi:10.1093/bjaceaccp/mkh048
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 6 2004 © The Board of Management and Trustees of the British Journal of Anaesthesia 2004

Acute coronary syndromes

LP Sheppard, BSc FRCA, Specialist Registrar in Intensive Care Medicine
Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF

KS Channer, MD FRCP, Consultant Cardiologist
Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF
Tel: 01142 712 086, Fax: 01142 712 042, E-mail: kevin.channer@sth.nhs.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Coronary artery disease accounts for >30% of deaths in Western society.

The diagnosis of myocardial infarction should be qualified by size, causation and time from occurrence.

Mortality is reduced by immediate or ‘primary’ percutaneous coronary intervention or thrombolysis within the first 24 h of onset of ST-segment elevation myocardial infarction.

Strategies to reduce platelet activation (glycoprotein IIb/IIIa receptor antagonists, or clopidogrel) are now recommended in the treatment of high-risk non-ST-segment myocardial infarction/unstable angina.

Elevated serum troponins may be the result of non-ischaemic myocardial damage, especially in critical illness.

 


   Pathophysiology
 
Changes in the definition of terms relating to the diagnosis of myocardial infarction (MI) have evolved by better understanding of the pathophysiology culminating in the new term of acute coronary syndrome (ACS). Figure 1 illustrates the processes that occur in the development of an acute coronary event.


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  		Fig. 1 Processes involved in reduction of blood flow during an acute coronary event.

 
The . . . [Full Text of this Article]


   Clinical scenarios
 
Unstable angina

Myocardial infarction


   Diagnosis of myocardial infarction
 
Electrocardiograph

Cardiac enzymes

Other investigations


   Management of ST-elevation myocardial infarction
 
Reperfusion

Aspirin

Secondary prevention


   Management of non-ST-segment myocardial infarction and unstable angina
 
Antithrombotic therapies

Aspirin

Antithrombin therapies

Glycoprotein IIb/IIIa inhibitors

Ticlopidine and clopidogrel

Direct antithrombins

Thrombolytic therapies

Statins

Other drug treatments


   Acute coronary syndrome and anaesthesia
 

   Troponins and critical illness
 

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