Materiały źródłowe

• #1 Acute Coronary Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459157/

  Acute coronary syndrome refers to a group of diseases in which blood flow to the heart is decreased. Some examples include ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. […] Acute coronary syndrome (ACS) refers to a group of conditions that include ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. It is a type of coronary heart disease (CHD), which is responsible for one-third of total deaths in people older than 35. Some forms of CHD can be asymptomatic, but ACS is always symptomatic. […] The classic symptom of ACS is substernal chest pain, often described as crushing or pressure-like feeling, radiating to the jaw and/or left arm. This classic presentation is not seen always, and the presenting complaint can be very vague and subtle with chief complaints often being difficulty breathing, lightheadedness, isolated jaw or left arm pain, nausea, epigastric pain, diaphoresis, and weakness. Female gender, patients with diabetes, and older age are all associated with ACS presenting with vague symptoms. A high degree of suspicion is warranted in such cases.

• #2 Acute coronary syndrome: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/315332

  Acute coronary syndrome describes a range of conditions associated with sudden, reduced blood flow to the heart. […] The signs and symptoms of acute coronary syndrome generally begin quickly, sometimes without warning, and can alert a person that something is wrong. Common symptoms include: Chest pain or discomfort, Pain or discomfort in one or both arms, the back, jaw, neck, or stomach, Shortness of breath, Dizziness or feeling lightheaded, Indigestion, Nausea or vomiting, Sweating. […] These symptoms are very serious and a person should seek emergency treatment immediately. Chest pain caused by acute coronary syndromes can come on suddenly without warning, which occurs during a heart attack. […] In other cases, the pain can be unpredictable and get noticeably worse even after rest, which is a symptom of unstable angina. Chest pain or discomfort is typically the most common symptom of acute coronary syndrome, but signs and symptoms vary depending on age, sex, and the presence of other medical conditions.

• #3 Acute coronary syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_coronary_syndrome

  Acute coronary syndrome (ACS) is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is centrally located pressure-like chest pain, often radiating to the left shoulder or angle of the jaw, and associated with nausea and sweating. Many people with acute coronary syndromes present with symptoms other than chest pain, particularly women, older people, and people with diabetes mellitus. […] Symptoms of the acute coronary syndromes are similar. The cardinal symptom of critically decreased blood flow to the heart is chest pain, experienced as tightness, pressure, or burning. Localization is most commonly around or over the chest and may radiate or be located to the arm, shoulder, neck, back, upper abdomen, or jaw. This may be associated with sweating, nausea, or shortness of breath.

• #4 Acute coronary syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/symptoms-causes/syc-20352136

  Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that needs a diagnosis and care right away. The goals of treatment are to improve blood flow and treat and prevent complications. […] The symptoms of acute coronary syndrome usually start suddenly. They include: Chest pain or discomfort. It may feel like aching, pressure, tightness or burning. Chest pain also is called angina. Pain that starts in the chest and spreads to other parts of the body. These areas include the shoulders, arms, upper belly area, back, neck or jaw. Nausea or vomiting. Pain or burning in the upper belly, called indigestion. Shortness of breath, also called dyspnea. Sudden, heavy sweating. Racing heartbeat. Feeling lightheaded or dizzy. Fainting. Unusual fatigue. […] Chest pain or discomfort is the most common symptom of acute coronary syndrome. But symptoms may vary a lot depending on age, sex assigned at birth and other medical conditions. Women, older adults and people with diabetes are more likely to have symptoms without chest pain or discomfort.

• #5 Acute Coronary Syndrome (ACS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22910-acute-coronary-syndrome

  People with ACS can experience unstable angina or a heart attack (myocardial infarction). Common signs include chest pain or pressure (angina), shortness of breath (dyspnea) or dizziness. […] Acute coronary syndrome is a medical emergency that requires immediate attention. Prompt treatment is important to ease symptoms and prevent complications. If you think you’re having a heart attack, take an aspirin and call 911 immediately. […] Symptoms of acute coronary syndrome vary based on the location and severity of the blockage. Your symptoms also depend on your age, sex and other medical conditions, like diabetes. […] Signs of ACS typically occur without warning, even while you rest. The syndrome often causes chest pain or discomfort (angina). This can feel like: Aching. Burning. Heaviness. Numbness. Pressure. Tightness.

• #6 Acute coronary syndrome Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/acute-coronary-syndrome

  Acute coronary syndrome is a term for a group of conditions that suddenly stop or severely reduce blood from flowing to the heart muscle. When blood cannot flow to the heart muscle, the heart muscle can become damaged. Heart attack and unstable angina are both acute coronary syndromes (ACS). […] The most common symptom of ACS is chest pain. The chest pain may come on quickly, come and go, or get worse with exercise or rest. Other symptoms can include: Pain in the shoulder, arm, neck, jaw, back, or belly area; Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching; Discomfort that occurs at rest and does not easily go away when you take medicine; Shortness of breath; Anxiety; Nausea; Sweating; Feeling dizzy or lightheaded; Fast or irregular heartbeat. […] In general, the quicker your artery gets unblocked, the less damage you will have to your heart. People tend to do best when the blocked artery is opened within a few hours from the time symptoms start.

• #7 Overview of Acute Coronary Syndromes (ACS) – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/overview-of-acute-coronary-syndromes-acs

  Symptoms are similar in each of these syndromes (except sudden death) and include chest discomfort with or without dyspnea, nausea, and diaphoresis. […] Symptoms of acute coronary syndromes depend somewhat on the extent and location of obstruction and are quite variable. Painful stimuli from thoracic organs, including the heart, can cause discomfort described as pressure, tearing, gas with the urge to eructate, indigestion, burning, aching, stabbing, and sometimes sharp needle-like pain. Many patients describe their symptoms as discomfort rather than pain. […] Symptoms of ACS are similar to those of angina and are discussed in more detail in sections on unstable angina and acute myocardial infarction. Of note, some patients with coronary artery disease (particularly patients with diabetes) have silent myocardial ischemia, which is typically detected during stress testing.

• #8 Acute coronary syndrome – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-coronary-syndrome/

  Acute coronary syndrome (ACS) is the clinical manifestation of myocardial infarct and commonly the default working diagnosis in patients with new-onset chest pain suspected to be of cardiac ischemic origin. Clinical findings (e.g., onset and characteristics of pain, patient history) in combination with ECG and troponin are the mainstays of diagnosis. […] Symptoms are not reproducible/predictable. Angina or anginal equivalent that is: Occurring at rest/with minimal exertion and is usually not relieved by rest or nitroglycerin. […] Classically, it has been taught that STEMI manifests with more severe symptoms than NSTEMI, but this is not always the case. […] Unstable angina is differentiated from MI by the presence of positive troponins, while the type of MI (NSTEMI vs. STEMI) is determined based on ECG findings.

• #9 Acute Coronary Syndrome Clinical Presentation: History, Physical Examination, ACP Screening Guidelines for CHD

  https://emedicine.medscape.com/article/1910735-clinical

  In addition, evidence exists that women more often have coronary events without typical symptoms, which may explain the frequent failure of clinicians to initially diagnose ACS in women. […] A summary of patient complaints is as follows: Palpitations, Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm, Exertional dyspnea that resolves with pain or rest, Diaphoresis from sympathetic discharge, Nausea from vagal stimulation, Decreased exercise tolerance. […] Stable angina involves episodic pain lasting 5-15 minutes, is provoked by exertion, and is relieved by rest or nitroglycerin. In unstable angina, patients have increased risk for adverse cardiac events, such as myocardial infarction or death. New-onset exertional angina can occur at rest and is of increasing frequency or duration or is refractory to nitroglycerin. Variant angina (Prinzmetal angina) occurs primarily at rest, is triggered by smoking, and is thought to be due to coronary vasospasm.

• #10 Acute Coronary Syndrome (ACS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22910-acute-coronary-syndrome

  Other common symptoms include: Dizziness, lightheadedness or fainting. Excessive, sudden sweating (diaphoresis). Fatigue. Racing or pounding heart (heart palpitations). Upper abdominal pain (can be mistaken for indigestion or heartburn). […] Women who have acute coronary syndrome often dont have chest symptoms. Theyre more likely to experience: Nausea or vomiting. Pain that spreads to the shoulders, neck, abdomen or jaw. Shortness of breath (dyspnea). […] The outlook for acute coronary syndrome depends on the specific condition and its severity, including the extent of heart muscle damage. Timely diagnosis and treatment, along with lifestyle changes, can help give you the best chance for a healthy life.

• #11 Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina

  About one third of people who have a heart attack do not have chest pain. […] Other symptoms include a feeling of faintness or actually fainting, sudden heavy sweating, nausea, shortness of breath, and a heavy pounding of the heart (palpitations). […] During a heart attack, a person may become restless, sweaty, and anxious and may experience a sense of impending doom. […] Older adults may have unusual symptoms. […] Despite all the possible symptoms, as many as 1 of 5 people who have a heart attack have only mild symptoms or none at all. […] During the early hours of a heart attack, heart murmurs and other abnormal heart sounds may be heard through a stethoscope. […] Many people who have unstable angina go on to have a heart attack within about 3 months. […] The most dangerous time for someone who is having a heart attack is during the first few hours, particularly before they arrive at the hospital.

• #12 Acute coronary syndrome: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007639.htm

  Acute coronary syndrome is a term for a group of conditions that suddenly stop or severely reduce blood from flowing to the heart muscle. When blood cannot flow to the heart muscle, the heart muscle can become damaged. Heart attack and unstable angina are both acute coronary syndromes (ACS). […] The most common symptom of ACS is chest pain. The chest pain may come on quickly, come and go, or get worse with exercise or rest. Other symptoms can include: Pain in the shoulder, arm, neck, jaw, back, or belly area. Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching. Discomfort that occurs at rest and does not easily go away when you take medicine. Shortness of breath. Anxiety. Nausea. Sweating. Feeling dizzy or lightheaded. Fast or irregular heartbeat. […] In general, the quicker your artery gets unblocked, the less damage you will have to your heart. People tend to do best when the blocked artery is opened within a few hours from the time symptoms start.

• #13 Acute coronary syndrome – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/acute-coronary-syndrome

  Symptoms of an acute coronary syndrome tend to come on suddenly. The most common symptom is chest pain and discomfort (angina). […] Other symptoms include: pain that spreads from the chest to the shoulders, arms, back, neck or jaw; feeling lightheaded, dizzy and/or fainting; fatigue; racing or pounding heartbeat (heart palpitations); pain that may be confused for heartburn or indigestion; nausea and/or vomiting; sudden sweating; shortness of breath. […] Symptoms can vary depending on age, sex and medical conditions. Women are less likely to experience the crushing chest pain typically associated with heart attack and more likely to experience: neck, jaw, shoulder, upper back, arm (one or both) or abdominal pain; shortness of breath; nausea or vomiting; fatigue; racing or pounding heartbeat (heart palpitations); sudden sweating; feeling lightheaded, dizzy and/or fainting.

• #14 Acute Coronary Syndrome: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/1910735-overview

  Acute coronary syndrome (ACS) refers to a spectrum of clinical presentations ranging from those for ST-segment elevation myocardial infarction (STEMI) to presentations found in nonST-segment elevation myocardial infarction (NSTEMI) or in unstable angina. It is almost always associated with rupture of an atherosclerotic plaque and partial or complete thrombosis of the infarct-related artery. […] Complaints reported by patients with ACS include the following: Palpitations, Pain, which is usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm, Exertional dyspnea that resolves with pain or rest, Diaphoresis from sympathetic discharge, Nausea from vagal stimulation, Decreased exercise tolerance.

• #14 Acute Coronary Syndrome: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/1910735-overview

  Updated guidelines for the management of non-ST-segment elevation ACS were released in 2020 by the European Society of Cardiology (ESC). The updates place increased reliance on high-sensitivity cardiac troponin testing (hs-cTn) for diagnosis. […] Initial therapy focuses on the following: Stabilizing the patients condition, Relieving ischemic pain, Providing antithrombotic therapy. […] Pharmacologic anti-ischemic therapy includes the following: Nitrates (for symptomatic relief), Beta blockers (eg, metoprolol): These are indicated in all patients unless contraindicated. […] Current guidelines for patients with moderate- or high-risk ACS include the following: Early invasive approach, Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or LMWH. […] Six-month mortality rates in the Global Registry of Acute Coronary Events (GRACE) were 13% for patients with NSTEMI ACS and 8% for those with unstable angina. […] An elevated level of troponin (a type of regulatory protein found in skeletal and cardiac muscle) permits risk stratification of patients with ACS and identifies patients at high risk for adverse cardiac events (ie, myocardial infarction, death) up to 6 months after the index event.

• #15 Symptoms, Outcomes and Risk Factors of ACS without Cardiac Chest Pain: Scoping Review | ECR Journal

  https://www.ecrjournal.com/articles/symptomology-outcomes-and-risk-factors-acute-coronary-syndrome-presentations-without?language_content_entity=en

  For patients experiencing acute coronary syndrome, early symptom recognition is paramount; this is challenging without chest pain presentation. […] Dyspnoea was the most reported and most prevalent symptom. Neurological symptoms, fatigue/weakness, nausea/vomiting, atypical chest pain and diaphoresis were also common. […] Patients without cardiac chest pain had worse outcomes: increased mortality, morbidity, greater prehospital and intervention delays and suboptimal use of guideline driven care. […] Current evidence suggests poor outcomes for patients presenting without cardiac chest pain, including longer prehospital delay, delayed diagnosis, lower likelihood of receiving a confirmed diagnosis of MI at admission, greater hospital complications, less guideline-driven medication and reperfusion efforts, and higher mortality rates.

• #16 Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7428604/

  Atypical symptom presentations are more common in women than men and may contribute to the lower likelihood of a diagnosis and treatment and result in poorer outcomes compared with men with MI. […] Many researchers have reported that upper back pain and fatigue are commonly reported symptoms during ACS, and up to 30% of patients do not experience chest pain. […] We found that although chest pain is a sensitive symptom for ACS, it is not very specific. In fact, few other symptoms were sensitive or specific for a diagnosis of ACS. […] We believe it is past time to standardize the symptom assessment so that proper and rapid diagnostic testing can be undertaken; however, we cannot standardize the symptom experience. When we do this, we are at risk of having study results such as those of Ferry et al, that vary from prior evidence and could lead to what the authors hope to avoid: disadvantaging women in receiving expeditious diagnostic testing and treatment for ACS.

• #17 Recognizing Acute Coronary Syndrome in Women

  https://www.uspharmacist.com/article/recognizing-acute-coronary-syndrome-in-women

  Differences in the rates of hospitalization secondary to AMI have been reported between males and females. […] Female patients admitted with AMI were more often black and had a history of smoking, hypertension, and diabetes mellitus. […] In fact, over a 20-year period, women had a 21% lower probability of receiving revascularization compared with men; although with these differences in overall management, 1-year all-cause mortality was similar between males and females. […] In-hospital mortality among women presenting with either STEMI (7.4% vs. 4.6%) or NSTEMI (4.8% vs. 3.9%) was found to be higher compared with males. […] While chest pain remains the most prevalent symptom upon presentation associated with AMI, women are more likely to experience symptoms other than chest pain. […] Atypical symptoms reported more frequently in women include chest pain described as sharp, burning, or aching and other symptoms such as fatigue, shortness of breath, dizziness, and indigestion.

• #18 Acute coronary syndrome in women

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/acute-coronary-syndrome-in-women

  The 2023 ESC Guidelines for the management of acute coronary syndromes (ACS) provide guidance to all physicians on the management of patients in a context of gender neutrality. […] Women with ACS often experience under- or delayed diagnosis and undertreatment. […] Clinical presentation of women with ACS may be atypical. […] As symptoms are often atypical in women with ACS, a comprehensive preliminary assessment of the woman with suspected ACS is of fundamental importance. […] Women have more diffuse and non-obstructive CAD, with a reduced plaque burden and calcium content. Notably, up to one-third of women experience myocardial infarction in the absence of obstructive coronary arteries (MINOCA). […] Chest pain is the most common clinical presentation of ACS. However, up to a quarter of women are more likely to present without chest pain, while reporting atypical symptoms, like jaw pain, nausea and vomiting, shortness of breath, palpitations, dizziness, and fatigue.

• #19 ACLS Cases: Acute Coronary Syndrome

  https://nhcps.com/lesson/acute-coronary-syndrome/?srsltid=AfmBOoqMAvm1s6YGEpyO1rGHN51l0N79OuzVy_ZzokDekd7pS_19WW6K

  Acute coronary syndrome (ACS) is a collection of clinical presentations including unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). ACS is classically recognized by one or more of the following symptoms: crushing chest pain, shortness of breath, pain that radiates to the jaw, arm, or shoulder, sweating, and/or nausea or vomiting. […] It is important to note that not all individuals with ACS will present with these classic findings, particularly women and individuals with diabetes mellitus. […] Every individual with these symptoms should be evaluated immediately.

• #20 Symptoms Suggestive of ACS – ACLS.com

  https://acls.com/articles/symptoms-suggestive-of-acs/

  Pain suggestive of acute coronary syndrome may also radiate to the back, jaw and arms. […] According to the American Heart Association, most patients will present with chest discomfort and shortness of breath as their predominant symptoms, but additional symptoms may occur. […] Although they may vary in intensity, some people experience lightheadedness, nausea and vomiting. […] Clinical presentation for patients with acute coronary syndrome may also include diaphoresis in the form of cold, clammy skin. […] Atypical presentations can occur, but they are more common in the elderly and in women. […] Individuals with diabetes sometimes also have atypical symptoms. […] According to the American Heart Association, women sometimes present with pain in the abdominal area, shortness of breath and fatigue. Similarly, the elderly may also present without chest pain- instead, shortness of breath, pain in the back or arms and fatigue may be present.

• #21 Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7428604/

  Studies indicate that symptoms labeled as atypical are more common in women evaluated for myocardial infarction (MI) and may contribute to the lower likelihood of a diagnosis and delayed treatment and result in poorer outcomes compared with men with MI. […] Atypical pain is frequently defined as epigastric or back pain or pain that is described as burning, stabbing, or characteristic of indigestion. Typical symptoms usually include chest, arm, or jaw pain described as dull, heavy, tight, or crushing. […] A more critical issue than sex differences in symptoms is likely the magnitude of symptom overlap in individuals ruled in and out for ACS. Approximately 10% to 15% of patients presenting to the emergency department (ED) with symptoms suggestive of ACS are actually experiencing ACS, yet the other 85% of patients look so similar that the same diagnostic testing and resources are required to safely rule them out for ACS.

• #22 Atypical MI Symptoms & Acute Coronary Syndrome: A Review — EMS.Aware — EMS.Aware

  https://www.emsaware.org/articlesforems/steminstemi

  The patient denied chest pain, shortness of breath, or any complaints besides nausea and weakness. […] Knowing that geriatric women, especially diabetics, have abnormal signs for cardiac issues, I decided to put a 12Lead on the patient just for good measure as my preceptor boarded the unit. […] An oxygen starved heart is failing to provide adequate perfusion – leading to an eventual state of hypoperfusion shock. Oxygen saturation may be low in MI patients, especially as it progresses. […] An MI compromises the hearts ability to effectively circulate blood – dropping perfusion. Weakness can be an easily missed sign of an MI. […] Unexplained, sudden onset weakness should raise your index of suspicion significantly. […] Atypical MI symptoms are hard to do justice – after all, they are atypical.

• #23 Acute Coronary Syndrome: Diagnostic Evaluation | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p170.html

  Myocardial infarction (MI), a subset of acute coronary syndrome, is damage to the cardiac muscle as evidenced by elevated cardiac troponin levels in the setting of acute ischemia. […] Chest pain is often the presenting symptom of myocardial infarction (MI), which is damage to the cardiac muscle caused by ischemia. […] Symptoms suggestive of cardiac ischemia include retrosternal chest pain (with or without radiation to either arm, the neck, or the jaw), oppressive chest pressure, abdominal pain, dyspnea, nausea, vomiting, diaphoresis, and syncope. […] In older persons, those with dementia or diabetes, and women, ischemic discomfort may present atypically, including epigastric discomfort, indigestion, pleuritic chest pain, and dyspnea. […] In a meta-analysis of symptoms useful in diagnosing ACS in a low-risk setting, diaphoresis was found to be the strongest predictor of MI (likelihood ratio [LR] = 2.44), and the presence of chest wall tenderness significantly reduced the possibility of MI (LR = 0.23).

• #24 Acute Coronary Syndrome | University of Ottawa Heart Institute

  https://www.ottawaheart.ca/heart-condition/acute-coronary-syndrome

  Unlike men, for some women, chest pain may not be the first sign of heart trouble. These women report less common symptoms, such as unusual tiredness, trouble sleeping, indigestion, and anxiety up to a month before the heart attack. Women with diabetes often have less common symptoms. […] Symptoms of Acute Coronary Syndrome in Men: Pain in the back, neck, and jaw; chest pain, heaviness, or tightness; shortness of breath; loss of consciousness; sweating; pain in the shoulder or arm; indigestion; nausea; stomach pain. […] Symptoms of Acute Coronary Syndrome in Women: Pain in the shoulder or arm, Shortness of breath, Chest pain, discomfort or pressure, Back pain, Tiredness, Trouble sleeping, Anxiety, Sweating, Indigestion.

• #25 NSTEMI: Causes, Symptoms, Diagnosis, Treatment & Outlook

  https://my.clevelandclinic.org/health/diseases/22233-nstemi-heart-attack

  NSTEMI is a type of acute coronary syndrome, which is an umbrella term for three conditions that cause a lack of blood flow to your heart. […] Without a steady supply of blood, a problem called ischemia happens. That means the affected part of your heart starts dying because it isn’t getting enough blood. […] NSTEMI can happen because of direct or indirect causes, including those listed below. […] People having a heart attack commonly describe these symptoms: Chest pain (angina). Trouble breathing or feeling short of breath. Nausea, stomach discomfort or pain (may feel like indigestion or heartburn). Heart palpitations (the unpleasant feeling of your own heartbeat; may also feel like your heart is skipping or adding extra heartbeats). Feeling lightheaded, dizzy or passing out. […] While women may experience any of the symptoms described above, they’re less likely to report symptoms of discomfort that feel like indigestion or pain in the center of their chest. They’re also more likely to report the following symptoms: Fatigue, shortness of breath or insomnia that began before the heart attack. Pain that radiates (spreads outward) to their jaw, neck, shoulders, arms, back or belly. Nausea and vomiting. […] The outlook for an NSTEMI depends on several factors. The severity of your heart attack and your overall health may change your outlook greatly. Your healthcare provider is the best person to explain what you should expect, as well as any problems you should watch for or things to avoid.

• #26 Acute Coronary Syndrome: Heart Symptoms in the 3 Types

  https://www.verywellhealth.com/acute-coronary-syndrome-8346870

  Acute coronary syndrome (ACS) is a medical term that categorizes three conditions that cause a sudden, life-threatening reduction of blood flow to the heart. Tight, squeezing chest pain (angina) is the most common symptom. All three types of ACS are life-threatening emergencies that require calling 911 for immediate medical attention. […] Symptoms associated with acute coronary syndrome can include: Chest pain that feels like squeezing, burning, or crushing; Pain in the jaw, arm, belly, shoulder, or neck; Nausea; Sweating; Anxiety; Rapid or irregular heartbeat; Lightheadedness. […] It is important to note that some people with acute coronary syndrome don’t experience any of the above symptoms. Silent myocardial ischemia or a silent heart attack is the phenomenon of people with insufficient blood flow to the heart not experiencing noticeable chest pain or other symptoms during an acute coronary syndrome emergency.

• #26 Acute Coronary Syndrome: Heart Symptoms in the 3 Types

  https://www.verywellhealth.com/acute-coronary-syndrome-8346870

  Any ACS symptoms should be treated as a „call 911” emergency. All three types of acute coronary syndrome are time-sensitive and require prompt emergency medical treatment at a hospital. […] Ideally, someone with ACS receives emergency medical treatment within 60 minutes of symptom onset. This 60-minute period is called the „golden hour” because getting ACS treatment during this critical time window can mean the difference between life and death. […] When someone is receiving emergency acute coronary syndrome care, healthcare providers try to establish when their heart attack symptoms started so they can provide appropriate treatment during the golden hour. Even if someone has been experiencing sporadic or vague symptoms, their official symptom onset time starts when ischemic symptoms last ten minutes or longer. […] Chest pain at rest that isn’t caused by physical exertion and lasts longer than 10 minutes can be a symptom of ACS. If you or someone you know is having ACS symptoms, call 911 immediately and get to a hospital via ambulance.

• #27 Acute Coronary Syndrome – Zero To Finals

  https://zerotofinals.com/medicine/cardiology/acs/

  Acute coronary syndrome typically presents with central, constricting chest pain. […] The chest pain is often associated with: Pain radiating to the jaw or arms, Nausea and vomiting, Sweating and clamminess, A feeling of impending doom, Shortness of breath, Palpitations. […] Symptoms should continue at rest for more than 15 minutes. […] A silent myocardial infarction is when someone does not experience typical chest pain during acute coronary syndrome. Patients with diabetes are particularly at risk of silent MIs.

• #28 Acute Coronary Syndrome (ACS) – Clinician Revision

  https://www.clinicianrevision.com/courses/cardiology/lessons/ischaemic-heart-disease/topic/acute-coronary-syndrome/

  Chest pain is the most important symptom. The pain is similar to angina but lasts longer and is more severe. […] Chest pain is typically central, crushing in character, lasts for over 20 minutes and may radiate to the jaw, neck, shoulders or arms (usually inner part of left arm). […] Other symptoms include: Shortness of breath, Sense of impending doom, Nausea and vomiting, Syncope, Vomiting (especially in inferior MI). […] Sudden death may occur due to asystole or ventricular fibrillation, especially within the first hour of symptom onset. […] Silent myocardial infarction refers to MIs with no or atypical symptoms; these may present in elderly and/or diabetic patients. They can be incidentally diagnosed using ECG or lab tests. […] Unstable angina: Ischaemia but no injury. Angina may progress to infarction if occlusion persists. […] NSTEMI: Subendocardial infarction. […] STEMI: Transmural infarction. […] STEMIs lead to transmural infarcts. NSTEMIs lead to subendocardial infarcts.

• #29 Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina

  People who experience an acute coronary syndrome usually have chest pressure or ache, shortness of breath, and/or fatigue. […] Symptoms of unstable angina are the same as those of angina pectoris; people typically have intermittent pressure, or an ache beneath the breastbone (sternum). […] About 2 of 3 people who have heart attacks experience unstable angina, shortness of breath, or fatigue a few days or weeks beforehand. Such a change in the pattern of chest pain discomfort may culminate in a heart attack. […] With a heart attack, the most recognizable symptom is usually pain in the middle of the chest that may spread to the back, jaw, or left arm. […] Less often, pain is felt in the abdomen, where it may be mistaken for indigestion, especially because belching may bring partial or temporary relief.

• #30 Acute coronary syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Acute_coronary_syndrome

  In unstable angina, symptoms may appear on rest or on minimal exertion. The symptoms can last longer than those in stable angina, can be resistant to rest or medicine, and can get worse over time. […] Though ACS is usually associated with coronary thrombosis, it can also be associated with cocaine use. Chest pain with features characteristic of cardiac origin (angina) can also be precipitated by profound anemia, brady- or tachycardia (excessively slow or rapid heart rate), low or high blood pressure, severe aortic valve stenosis (narrowing of the valve at the beginning of the aorta), pulmonary artery hypertension and a number of other conditions.

• #31 Symptoms, Outcomes and Risk Factors of ACS without Cardiac Chest Pain: Scoping Review | ECR Journal

  https://www.ecrjournal.com/articles/symptomology-outcomes-and-risk-factors-acute-coronary-syndrome-presentations-without?language_content_entity=en

  Older age, female sex, ethnicity, comorbidities such as diabetes and hypertension, previous medical events, including stroke and acute MI, are often believed to be associated with such presentations. […] Of all the included articles, 28/41 reported common cardiovascular disease risk factors frequently hypothesised to be a predictor of ACS presentation without cardiac chest pain. […] Overall outcomes for ACS presentations without cardiac chest pain were overwhelmingly poor. […] Patients without cardiac chest pain consistently had higher rates and severity of HF, delayed first medical contact/hospital presentation from symptom onset, longer ECG acquisition and door-to-balloon times, reduced guideline adherence including regarding medication administration during admission and at discharge.

• #32 Contemporary Risk Stratification of Acute Coronary Syndrome

  https://www.uscjournal.com/articles/contemporary-risk-stratification-acute-coronary-syndrome?language_content_entity=en

  Angina pectoris is defined as chest discomfort attributed to myocardial ischemia. […] Studies have shown greater angina severity at the time of diagnosis to be associated with higher mortality rates, cardiovascular hospitalizations, coronary revascularization, and overall healthcare costs. […] Elevated cTn concentrations are strongly associated with an increased risk of index and recurrent cardiovascular events. […] The relationship between baseline cTn and outcomes in patients with NSTE ACS has been well established, with higher cTn concentrations being associated with significantly higher 30-day mortality in the GUSTO-IIa troponin T substudy. […] Patients presenting with chest pain and classified as high risk for ACS need urgent ICA because a delay in intervention can cause irreversible myocardial loss.

• #33 Acute coronary syndrome in women

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/acute-coronary-syndrome-in-women

  Women are less likely to present with ST-elevation myocardial infarction (STEMI) and any ST-elevation is usually less marked than in men. […] Myocardial infarction can be diagnosed with a rise and/or fall of cardiac biomarkers, in a clinical context of acute myocardial ischaemia. […] Several studies have suggested that women have worse outcomes than men after an ACS. […] Women with STEMI have a 7% lower probability of receiving angiography and a 21% lower probability of receiving revascularisation. […] Women with ACS have a 17% lower probability of receiving non-aspirin antiplatelets, as compared to men. […] Women are less likely to receive medications for secondary prevention, having a 4% lower probability of receiving beta-blockers, 5% for ACE inhibitors, and 13% for lipid-lowering medications. […] Women often experience high family stress levels, and many competing and conflicting priorities, factors that can ultimately lead to delays in presentation.

• #34 Acute Coronary Syndrome: Current Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0215/p232.html

  At the individual level, patients should be advised to chew a nonenteric coated aspirin (162 to 325 mg) at first recognition of ACS symptoms, unless they have a history of severe aspirin sensitivity. […] Electrocardiographic findings that may reflect myocardial ischemia include changes in the PR segment, QRS complex, and the ST segment. […] The goal of medical management is to administer fibrinolytic therapy within 30 minutes of first medical contact. […] After STEMI has been identified, the most appropriate strategy for reperfusion should be determined quickly. […] Prompt restoration of flow in an occluded artery is the most important factor in defining short- and long-term outcome, regardless of the method. […] Current guidelines recommend against the use of fibrinolytic agents in patients with NSTE-ACS because of an increased risk of reinfarction and other complications. […] The key to reducing the risk of morbidity and mortality is a secondary prevention plan, which should be closely coordinated with the patient’s cardiologist.

• #35 Understanding Acute Coronary Syndrome: Causes, Symptoms, and Diagnosis

  https://avicennacardiology.com/manhattan/acute-coronary-syndrome

  Prompt diagnosis of acute coronary syndrome is essential to restore blood flow and minimize damage to the heart muscle. […] If not treated promptly, acute coronary syndrome can lead to complications such as heart failure, severe valve leakage or stroke, heart muscle tamponade, and arrhythmias. […] Early intervention during the golden hour significantly improves survival rates and reduces complications.

• #36 Recognizing Acute Coronary Syndrome in Women

  https://www.uspharmacist.com/article/recognizing-acute-coronary-syndrome-in-women

  In addition to being at risk of underdiagnosis, delays in receiving medical care have also been noted in women. […] Many factors play a role in delays in care, including symptom recognition by the patient, but inadequate prehospital evaluation and/or lack of early diagnosis of women upon presentation is also a contributing factor. […] Delays in presentation among patients with chest pain determined to be due to an AMI are significantly greater in women compared with men. […] However, studies have demonstrated that women have longer delays to an initial ECG compared with men. […] Due to the time-sensitive nature of these revascularization strategies, significant delays in presentation or diagnosis may place women at risk of poor outcomes. […] Women experience increased rates of mortality following an AMI; however, through development of strategies to increase recognition of symptoms, minimize prehospital delays, and increase the rate of medical treatment, we may impact these detrimental clinical outcomes.

• #37 Acute coronary syndromes presentations and care outcomes in white, South Asian and Chinese patients: a cohort study | BMJ Open

  https://bmjopen.bmj.com/content/9/3/e022479

  South Asians were significantly more likely to report having midsternal pain/discomfort of moderate to severe intensity. […] The mean time to ER presentation, for those who had a distinct time of symptom onset, was 5.53 to 7.41 hours. […] South Asians with atypical symptoms had significantly longer delays in arrival to the emergency department than those who had any typical symptoms. […] Overall, and after adjustment, South Asians with atypical symptoms were least likely of the ethnic groups to receive PCI than those with typical symptoms.

• #38 Acute Coronary Syndrome | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=uf9684

  Acute coronary syndrome is an emergency. It happens when the heart muscle is not getting enough blood and oxygen. […] Acute coronary syndrome includes unstable angina and heart attack. […] Symptoms of acute coronary syndrome include: Chest pain or pressure, or a strange feeling in the chest. Shortness of breath. Sweating. Nausea or vomiting. Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms. Lightheadedness, sudden weakness, or passing out. A fast or irregular heartbeat. […] The most common symptom is chest pain or pressure. But many people have other symptoms like shortness of breath, tiredness, nausea, and back or jaw pain. People may have more than one symptom. […] People also describe the symptoms as discomfort, pressure, squeezing, or heaviness in the chest. The pain may spread down the left shoulder and arm and to other areas. […] People with unstable angina often describe their symptoms as different from their typical pattern of stable angina. For example, symptoms might happen when they’re at rest, feeling stressed, or not using much energy.

• #39 Acute Coronary Syndrome | Step-by-Step Emergency Guide

  https://baysidecpr.com/acute-coronary-syndrome-algorithm

  The first thing emergency teams do is assess the patient. […] Start the initial treatment as soon as you identify the type of ACS or even before all the test results are in. […] After stabilizing the patient, additional tests confirm the type of ACS. […] Once you confirm the type of ACS, find out how serious it is. […] Treat STEMI patients with primary PCI (Percutaneous Coronary Intervention), commonly known as angioplasty, as the first-line approach. […] After the immediate crisis is managed, most patients will need ongoing medication to protect their heart and prevent future issues. […] Once patients are out of immediate danger, the focus shifts to recovery and preventing another episode. […] When it comes to Acute Coronary Syndrome, the difference between a full recovery and lasting damage often comes down to how quickly you respond. Early signs can be subtle, and many people dont recognize them until its almost too late. Understanding these signs and knowing what steps to take can save lives.

• #40 Acute Coronary Syndrome – Armando Hasudungandownloadbookprintpencilchevron-leftchevron-righttwitterfacebookhand-o-rightfilterchainlist-ulenvelopelinkedinangle-rightangle-upyoutubexinginstagramlong-arrow-uppaper-planepinterest-pwhatsappcommentingaddress-bo

  https://armandoh.org/disease/acute-coronary-syndrome/?srsltid=AfmBOoo3InrJ3y8uFKRRnGwFFa7IaWo82gmypesvqQsQ5N4WslkY84tP

  Retrosternal Pain (for at least 30min), which radiates to the neck, arms and jaw. The pain is described as crushing, heaviness or like a tight band. Worse with physical or emotional exertion. Not relieved by rest. Nitrate spray (within a couple of minutes) may not always relieve the pain. Acute coronary syndrome may be accompanied with diaphoresis, feeling of impending doom and breathless. […] Signs of impaired myocardium […] Hypotension, Oligouria […] Raised JVP […] Narrow pulse pressure […] Third heart sound […] Lung crepitation (pulmonary edema). […] Chest pain with high suspicion of Acute Coronary syndrome (history, examination and risk factors) […] Typical chest pain persisting for more than 30 minutes […] Typical ECG findings […] Elevated cardiac biomarker levels. […] Early reperfusion with PCI or thrombolytics reduces mortality and preserves ventricular function in patients who have ST-segment elevation, have no contraindications, and receive treatment within the first 6 to 12 hours.

• #41

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-cardiovascular/acute-coronary-syndromes

  Diagnostically, there are two major goals for patients presenting to the ED with chest pain. The first goal is to rule in an acute MI (STEMI/NSTEMI) or other emergent reason for the need for cardiac intervention. The second is to risk stratify patients for future coronary events. […] An acute MI is diagnosed by satisfying two of the following three criteria: Clinical history consistent with ACS, EKG changes, Elevation in troponin enzymes. […] Patients that have EKGs that do not meet the above discussed STEMI criteria but have ischemic changes (ST depressions, T wave inversions or hyperacute T waves) and/or positive troponins are classified as non-ST segment elevation MIs (NSTEMI). The acute management of these patients involves relief of ischemic pain, maintaining/correcting hemodynamics, antithrombotic therapy as well as management strategy.

• #42 Acute coronary syndrome – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/diagnosis-treatment/drc-20352140

  Acute coronary syndrome is an emergency. It’s usually diagnosed at a hospital. The healthcare team runs tests to check the heart and determine the cause of symptoms. Some tests may be done while the healthcare team asks you questions about your symptoms or medical history. […] Your healthcare team looks at your symptoms and test results to diagnose acute coronary syndrome. This information also can help classify your condition as a heart attack or unstable angina. […] If you have sudden chest pain or other symptoms of acute coronary syndrome, get emergency care right away or call 911.

• #43 Acute Coronary Syndrome – Ischemic Heart Disease | Choose the Right Test

  https://arupconsult.com/content/acute-coronary-syndrome

  Acute coronary syndrome (ACS, formerly called ischemic heart disease) refers to a large spectrum of clinical conditions including unstable angina, myocardial injury, and myocardial infarction (MI). ACS is caused by a sudden onset of cardiac tissue ischemia secondary to impaired blood flow. The resulting tissue ischemia can cause changes on an electrocardiogram (ECG), as well as symptoms such as substernal chest pressure and radiation of pain to the left arm, shoulder, or jaw. Patients who present with symptoms of ACS, including chest pain, should be immediately evaluated. […] cTn levels are generally elevated within 2-4 hours of symptom onset but may not become abnormal for up to 12 hours. cTn elevations may persist for 14 days. […] The presence and magnitude of cTn elevations at presentation are useful for prognosis of short- and long-term mortality in ACS.

• #44 Contemporary Risk Stratification of Acute Coronary Syndrome

  https://www.uscjournal.com/articles/contemporary-risk-stratification-acute-coronary-syndrome?language_content_entity=en

  High-risk patients include those classified as high risk by CDP score, persistent chest pain, hemodynamic instability, elevated cardiac troponin confirming myocardial injury, new ischemic changes on ECG, new left ventricular systolic dysfunction (ejection fraction 40%), or newly diagnosed moderate-severe ischemia on functional testing.

• #45

• #46

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-cardiovascular/acute-coronary-syndromes

  Just as common as typical presentations of ACS are atypical presentations. Atypical presentations commonly occur more frequently in women, diabetics and elderly. The pain can occur anywhere from the umbilicus to the neck and to the back. It can be sharp, burning (simulating gastric reflux) or only be associated with mild discomfort. Diabetics and the elderly may have no chest pain at all. Women often present simply with fatigue, shortness of breath and generalized weakness. […] The continuum of cardiac chest pain starts with stable angina (unchanged exertional pain lasting 5-15 minutes and relieved by rest or nitroglycerin). Unstable angina (increasing in frequency, at lower exertional levels, occurs at rest or unrelieved by rest or nitroglycerin) is the beginning of the ACS continuum. The spectrum, encompassing NSTEMI and STEMI, is quite dynamic and may lead to MI or death.

• #47 Acute Coronary Syndrome: Current Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0215/p232.html

  Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. […] It is important for primary care physicians to be able to diagnose and manage acute coronary syndrome (ACS), which comprises two clinical presentations: ST elevation myocardial infarction (STEMI) and nonST elevation acute coronary syndrome (NSTE-ACS). […] The average age at first myocardial infarction (MI) is 65 years in men and 72 years in women. […] Although evidence shows decreased rates of hospitalization and mortality in patients receiving appropriate treatment, ACS continues to be the most common cause of death in the United States. […] Family physicians should continue to educate patients about the risk factors, clinical presentation, and symptoms of ACS. Older persons, persons with diabetes, women, and postoperative patients should be aware that they may have atypical symptoms and presentation for ACS.

• #48 Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina

  Most people who survive for a few days after a heart attack can expect a full recovery, but about 10% die within a year. […] Most deaths occur in the first 3 or 4 months, typically in people who continue to have angina, abnormal heart rhythms originating in the ventricles (ventricular arrhythmias), or heart failure.

• #49 Acute Coronary Syndrome Symptoms, Doctors, Treatments, Advances & More | MediFind

  https://www.medifind.com/conditions/acute-coronary-syndrome/5610

  How well you do after an ACS depends on: How quickly you get treated; The number of arteries that are blocked and how bad the blockage is; Whether or not your heart has been damaged, as well as the extent and location of the damage, and where the damage is. In general, the quicker your artery gets unblocked, the less damage you will have to your heart. People tend to do best when the blocked artery is opened within a few hours from the time symptoms start. […] An ACS is a medical emergency. If you have symptoms of an ACS, call 911 or the local emergency number quickly. Do not: Try to drive yourself to the hospital. Wait – If you are having a heart attack, you are at greatest risk for sudden death in the early hours.

• #50 Acute Coronary Syndrome: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/1910735-overview

  Physical findings can range from normal to any of the following: Hypotension: Indicates ventricular dysfunction due to myocardial ischemia, myocardial infarction (MI), or acute valvular dysfunction, Hypertension: May precipitate angina or reflect elevated catecholamine levels due to anxiety or to exogenous sympathomimetic stimulation, Diaphoresis, Pulmonary edema and other signs of left heart failure, Extracardiac vascular disease, Jugular venous distention, Cool, clammy skin and diaphoresis in patients with cardiogenic shock, A third heart sound (S3) and, frequently, a fourth heart sound (S4), A systolic murmur related to dynamic obstruction of the left ventricular outflow tract, Rales on pulmonary examination (suggestive of left ventricular dysfunction or mitral regurgitation). […] Potential complications include the following: Ischemia: Pulmonary edema, Myocardial infarction: Rupture of the papillary muscle, left ventricular free wall, and ventricular septum.

• #51 Acute Coronary Syndrome | Step-by-Step Emergency Guide

  https://baysidecpr.com/acute-coronary-syndrome-algorithm

  Every year, thousands of people rush to emergency departments with chest pain. Some walk in on their own, while others are carried in urgently. Regardless of how they arrive, the next 10 to 30 minutes are crucial. In that moment, recognizing ACS, starting appropriate treatment, and making the right clinical decisions can be the difference between survival and lasting heart damage or worse. […] Acute Coronary Syndrome isnt a single conditionits a term that covers several problems related to reduced blood flow to the heart. That reduction is usually caused by a blockage in one or more coronary arteries, most often due to a blood clot. […] There are three main types of ACS: ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), and Unstable Angina. […] Knowing how to respond when ACS is suspected can save lives.

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