page_title: Management of acute coronary syndrome
section_title: Initial diagnostic approach
hierarchical_section_title: Management of acute coronary syndrome / Initial diagnostic approach
caption_attribution_description: 12 Lead ECG EKG showing ST Elevation (STEMI), Tachycardia, Anterior Fascicular Block, Anterior Infarct, Heart Attack. Color Key: ST Elevation in anterior leads=Orange, ST Depression in inferior leads=Blue
context_page_description: Management of acute coronary syndrome is targeted against the effects of reduced blood flow to the afflicted area of the heart muscle, usually because of a blood clot in one of the coronary arteries, the vessels that supply oxygenated blood to the myocardium. This is achieved with urgent hospitalization and medical therapy, including drugs that relieve chest pain and reduce the size of the infarct, and drugs that inhibit clot formation; for a subset of patients invasive measures are also employed. Basic principles of management are the same for all types of acute coronary syndrome. However, some important aspects of treatment depend on the presence or absence of elevation of the ST segment on the electrocardiogram, which classifies cases upon presentation to either ST segment elevation myocardial infarction or non-ST elevation acute coronary syndrome; the latter includes unstable angina and non-ST elevation myocardial infarction. Treatment is generally more aggressive for STEMI patients, and reperfusion therapy is more often reserved for them. Long-term therapy is necessary for prevention of recurrent events and complications.
context_section_description: In patients with symptoms typical of myocardial ischemia an electrocardiogram must be immediately obtained - e.g., within 10 minutes from first contact with medical or paramedical personnel, including prehospital setting; the electrocardiographic findings will guide the subsequent management. Patients with elevation of the ST segment (or presumed new left bundle branch block) are treated based on guidelines for ST elevation myocardial infarction (STEMI) and must undergo reperfusion therapy as soon as possible. Serum cardiac biomarkers are routinely obtained and their elevation is necessary for confirming diagnosis of myocardial infarction; however, reperfusion must not be delayed by waiting for the results. Patients without the above findings are initially classified as suffering from non ST elevation acute coronary syndrome, and subsequent cardiac biomarker results will differentiate between true non ST elevation myocardial infarction (NSTEMI) and unstable angina.
caption: Typical electrocardiogram of an ST segment elevation myocardial infarction. ST elevation in leads I, aVL and V1-V5 indicates an anterior wall myocardial infarction and is shown in orange; reciprocal ST depression in leads II, III and aVF is shown in blue.
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