Medicus, Vol. 12 No. 1_ Kardiologija, 2003.
Pregledni rad
The Approach to the Patient with Acute Coronary Syndrome
Davor Miličić
Sažetak
Acute coronary syndrome (ACS) has been
discussed regarding definition, epidemiology, diagnosis and
differential diagnosis. In patients with suspected ACS it is
essential to establish working diagnosis, based on the typical
clinical presentation and ECG findings. Primarily, ACS with STelevation
has to be distinguished from ACS without ST-elevation.
In the case of elevated troponin I or T and/or elevated
CK-MB, the diagnosis of myocardial infarction has to be established,
also considering ST-changes in ECG: ST-elevation
myocardial infarction (STEMI) and non-ST elevation myocardial
infarction (NSTEMI). Working diagnosis has to be established
as soon as possible, because of the highest urgency to start
therapy, particularly in the case of STEMI. Patients with STEMI
have to be treated immediately either with fibrinolysis or by
intervention revascularization. The results of percutaneous
coronary interventions (PCI) are nowadays superior to fibrinolytic
regimen, but most important is to ensure any of these
effective treatments urgently. After 6 or maximally 12 hours
there are no measurable effects either of fibrinolytic or acute
intervention approach, because of the irreversible myocardial
damage. In a case of NSTEMI, interventional treatment is the
optimal choice as well, but the patient could be pharmacologically
stabilized and then sent to intervention procedure 24-72
hours after the symptom onset. In high-risk patients with
NSTEMI (significant ST-depression and/or troponin elevation)
invasive treatment should be considered as soon as possible.
Furthermore, some important aspects of pharmacological ACS
therapy are presented, particularly regarding some types of
drugs that have been proven not only to treat symptoms, but
also to effectively reduce mortality long-term. In this context
aspirin, beta blockers and ACE inhibitors are discussed, as
well as the need for strict regulation of hyperlipidemia with the
application of statins, and hyperglicemia with insulin.
Ključne riječi
acute coronary syndrome; diagnosis; treatment
Hrčak ID:
20513
URI
Datum izdavanja:
27.1.2003.
Posjeta: 7.828 *