Acute Coronary Syndrome

Abstract

As noted by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, “Acute Coronary Syndrome (ACS) has evolved as a useful operational term that refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction due to an abrupt reduction in coronary blood flow.” The critical tools for the clinician to place patients on this spectrum and prioritize their care are the electrocardiogram (ECG) and troponin assays, the specific cardiac biomarkers of necrosis. A key branch point is the presence of ST-segment elevation (ST elevation) or new left bundle branch block on a patient’s ECG, which is pathognomonic of an ST elevation myocardial infarction (STEMI). STEMI is an indication for immediate coronary angiography to determine if there is an opportunity for reperfusion therapy to open a likely completely occluded coronary artery. The role of the critical care surgeon in acute coronary syndrome is to recognize the presence of this clinical syndrome in the perioperative or trauma patient. Recognition is the crucial first step in rescuing these patients. Once a patient is found to have ACS, proper assignment to STEMI or NSTE-ACS pathways will guide the urgency of consultations and interventions by cardiologists and cardiac surgeons. The critical care surgeon will need to remain engaged as the subject matter expert with regard to the patient’s ability to tolerate various anticoagulation, intervention, and cardiac surgical therapies in relation to their current condition and potential need for further surgical intervention.