Acute Coronary Syndromes in the ER

  • Carlos Jerjes-SánchezEmail author
  • Hector Betancourt
  • Felipe Valdés
  • David Rodríguez
  • Mauricio Vázquez Guajardo
  • Raul del Toro-Mijares


Acute coronary syndromes remain a public health concern that has a negative impact on the quality of life of thousands of patients worldwide and represents an important economic burden for health-care systems. To reduce ACS morbidity and mortality in the emergency room (ER), an expedite and accurate diagnosis of acute ischemic heart disease is mandatory. Rapid identification of coronary syndromes leads to prompt and optimal treatment, therefore reducing the burden of chronic disease if patients achieve revascularization within an optimal time frame. Over the last decades, public awareness has increased, and better drugs are being marketed, leading to a substantial decrease in ACS mortality. Currently, women and geriatric patients account for most of the ACS-related mortality. Often, these groups of patients tend to arrive at the ER with atypical symptomatology, which might mislead clinicians into time-consuming and wrong diagnostic approaches. This chapter summarizes ACS pathology, classification, clinical presentation, risk stratification, biomarker use, imaging modalities, as well as the most universally accepted diagnostic and therapeutic strategies. It also considers special ACS subpopulations like women and the elderly, in whom correct diagnosis and proper treatment selection pose a challenge. By implementing some of the most traditional and validated risk scores, high-sensitivity biomarkers, and fast noninvasive imaging, patient triage can be expedited even in the setting of highly atypical clinical presentations. Up-to-date pharmacologic therapies can be adapted to these special subpopulations depending on every patient’s risk.


Myocardial infarction Chest pain Acute coronary syndrome Heart attack Unstable angina STEMI NSTEMI 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Carlos Jerjes-Sánchez
    • 1
    • 2
    Email author
  • Hector Betancourt
    • 1
  • Felipe Valdés
    • 1
  • David Rodríguez
    • 1
    • 2
  • Mauricio Vázquez Guajardo
    • 3
  • Raul del Toro-Mijares
    • 1
    • 3
  1. 1.Instituto de Cardiología y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnológico de MonterreySan Pedro Garza GarcíaMéxico
  2. 2.Centro de Investigación Biomédica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina, Tecnológico de MonterreySan Pedro Garza GarcíaMéxico
  3. 3.Escuela de Medicina y Ciencias de la Salud, Tecnológico de MonterreyMonterreyMéxico

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