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This section introduces ACS and covers the diagnosis of the condition
ACS is an umbrella term encompassing the following clinical disorders:3
It is estimated that an MI, commonly referred to as a heart attack, occurs every 40 seconds in the US, with 14% of these occurrences resulting in death.4
Most cases of ACS are caused by the erosion or rupture of an atherosclerotic plaque, a thickening of the vessel wall in a coronary artery.5
The thrombus restricts the flow of blood to the heart. A prolonged lack of blood supply resulting in necrosis (death) of heart muscle tissue is defined as an MI.3 The degree of arterial blockage caused by the thrombus determines the amount of myocardial damage that occurs and the type (and severity) of ACS that results:3,7
Coronary artery with thin muscular media and prominent intimal hyperplasia with calcification. Lumen obstructed by thrombus (arrow)
Cardiac muscle damage in ACS. An area of cardiac muscle damage due to acute occlusion in a coronary artery that delivers blood to that area
Patients with ACS typically present with acute chest pain. The main methods used to confirm a diagnosis of ACS and to distinguish between the three types of ACS are as follows:8
ECG: UA and NSTEMI are associated with ST depression/transient elevation and/or T-wave changes; persistent ST elevation is characteristic of STEMI
Illustration of normal ECG and ECGs showing STEMI and NSTEMI
Diagnosing the spectrum of ACS8