ACS Mastery Quiz

Acute Coronary Syndrome (ACS) refers to a myocardial oxygen supply and demand mismatch caused by the inability of coronary arteries to accommodate an increased oxygen demand, often due to atherosclerotic disease. Approximately 15.5 million patients are affected by ACS, and it is the most common chief complaint in the emergency department. Ischemic Heart Disease is the leading cause of death and Years of Life Lost. The Fourth Universal Definition of MI includes detection of a rise and/or fall of cTn with at least one value above the 99th percentile and with at least one of the following: 1. Symptoms of acute myocardial ischemia; 2. New ischemic electrocardiographic (ECG) changes; 3. Development of pathological Q waves; 4. Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology; 5. Identification of a coronary thrombus by angiography including intracoronary imaging or by autopsy. Diagnosis includes clinical symptoms such as chest pain, physical exam signs, electrocardiogram, and lab tests. Treatment includes aspirin, oxygen if under 90%, 12-lead EKG, activation of cardiac cath lab, morphine for pain control, and nitroglycerin sublingual or spray if indicated. The major adverse cardiac event score (MACE) is used to determine the course of action for patients with ACS. The preferred method of reperfusion is PCI, and the cath lab should be activated regardless of the method of reperfusion if hemodynamic or electrical instability or failed fibrinolysis occurs.