Diagnosis and Risk Stratification in Acute Coronary Syndromes

Abstract

Acute coronary syndromes usually present as acute chest pain but a manifestation with atypical symptoms or entirely without symptoms makes rapid diagnosis of this potentially lethal syndrome difficult and may lead to delay of the appropriate therapy. The role of the practitioner in this situation is complex since early exclusion of an acute coronary syndrome may be very difficult with the means available in a private practice; on the other hand the early hours which are critical for early therapy may be lost in a private practice. In the early phase of an acute coronary syndrome, diagnoses and risk stratification are based primarily on history, clinical presentation, ECG and biological markers. In the hospital, the time course of these parameters, functional tests for diagnosis and risk stratification as well as determination of left ventricular function and coronary angiography have additional relevance. Recent developments are the availability of highly sensitive and specific biological markers (Troponins), the new classification in acute coronary syndrome with and without ST-elevation and the identification of inflammatory processes in the coronary artery, which have added importantly to our understanding of the acute coronary syndrome. The availability of very early therapy and the possibilities of telemedicine have the potential to influence the pre-hospital diagnostic strategy and management of acute coronary syndromes.