Skip to main content

Acute Coronary Syndrome: Clinical Assessment

  • Chapter
Clinical Applications of Cardiac CT
  • 1465 Accesses

Abstract

The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non ST-segment elevation (NSTE) myocardial infarction (MI) to ST-segment elevation (STE) MI. UA and NSTEMI are closely related conditions, in fact their pathophysiologic origins and clinical presentations are similar, but they differ in severity. The pathogenesis of ACS involves a complex interplay among the endothelium, the inflammatory cells, and the thrombogenicity of the blood. Autopsy studies have shown that plaque rupture causes approximately 75% of fatal MIs, whereas superficial endothelial erosion accounts for the remaining 20–25% [15].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bassand JP, Hamm CW, Ardissino D et al (2007) Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 28:1598–1660

    Article  PubMed  CAS  Google Scholar 

  2. Anderson JL, Adams CD, Antman EM et al (2007) Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina / Non-ST-Elevation Myocardial Infarction. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction. J Am Coll Cardiol 50:1–157

    Article  Google Scholar 

  3. Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 29:2909–2945

    Article  PubMed  Google Scholar 

  4. Antman EM, Anbe DT, Armstrong PW et al (2004) Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction. J Am Coll Cardiol 44:671–719

    Article  PubMed  Google Scholar 

  5. Zipes DP, Libby P, Bonow RO, Braunwald E (2005) Part II (Examination of the Patient) and Part IV (Atheroslcerotic Cardiovascular Disease). In: Braunwlad’s Heart Disease: a Textbook of Cardiovascular Medicine, 7th edn. Elsevier Saunders, Philadelphia, USA

    Google Scholar 

  6. Braunwald E, Jones RH, Mark DB et al (1994) Diagnosing and managing unstable angina. Agency for Health Care Policy Research. Circulation 90:613–622

    PubMed  CAS  Google Scholar 

  7. Campeau L (1976) Letter: Grading of angina pectoris. Circulation 54:522–523

    PubMed  CAS  Google Scholar 

  8. Braunwald E (1989) Unstable angina: a classification. Circulation 80:410–414

    Article  PubMed  CAS  Google Scholar 

  9. Platelet Receptor Inhibition for Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISMPLUS) Trial Investigators (1998) Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction [published correction appears in N Engl J Med 1998; 339:415]. N Engl J Med 338:1488–1497

    Article  Google Scholar 

  10. Cannon CP, McCabe CH, Stone PH et al (1997) The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. J Am Coll Cardiol 30:133–140

    Article  PubMed  CAS  Google Scholar 

  11. Savonitto S, Ardissino D, Granger CB et al (1999) Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA 281:707–713

    Article  PubMed  CAS  Google Scholar 

  12. Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538

    Article  PubMed  Google Scholar 

  13. Giugliano RP, Braunwald E (2010) The year in non ST-segment elevation acute coronary syndromes. J Am Coll Cardiol 25:2126–2138

    Article  Google Scholar 

  14. Morrow DA, Antman EM, Charlesworth A et al (2000) TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an Intravenous nPA for Treatment of Infarcting Myocardium Early II trial substudy. Circulation 102:2031–2037

    PubMed  CAS  Google Scholar 

  15. Antman EA, Cohen M, Bernink PJLM et al (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284:835–842

    Article  PubMed  CAS  Google Scholar 

  16. Granger CB, Goldberg RJ, Dabbous OH et al for the GRACE Investigators (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 163:2345–2353

    Article  PubMed  Google Scholar 

  17. Eagle KA, Lim MJ, Dabbous OH et al for the GRACE investigators (2004). A validated prediction model for all forms of acute coronary syndrome. Estimating the risk of 6-month postdischarge death in an international registry. JAMA 291:2727–2733

    Article  PubMed  CAS  Google Scholar 

  18. Fox KAA, Dabbous OH, Goldberg RJ et al (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study — GRACE. BMJ 333:1091–1094

    Article  PubMed  Google Scholar 

  19. Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 3:2501–2555

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Italia

About this chapter

Cite this chapter

Buja, P., Tarantini, G. (2012). Acute Coronary Syndrome: Clinical Assessment. In: Cademartiri, F., Casolo, G., Midiri, M. (eds) Clinical Applications of Cardiac CT. Springer, Milano. https://doi.org/10.1007/978-88-470-2522-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2522-6_5

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2521-9

  • Online ISBN: 978-88-470-2522-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics