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Acute coronary syndrome

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Acute coronary syndrome (ACS) is a spectrum of acute myocardial ischemia caused most often by coronary plaque rupture with thrombosis. It includes:
  1. Unstable angina
  2. NSTEMI - non-ST-elevation myocardial infarction
  3. STEMI - ST-elevation myocardial infarction
A complete ACS study guide is best divided into:
  1. Definition, pathophysiology, and classification
  2. Risk factors and clinical presentation
  3. Initial assessment and differential diagnosis
  4. ECG interpretation and localization of infarction
  5. Cardiac biomarkers, especially high-sensitivity troponin
  6. Risk stratification - GRACE, TIMI, bleeding risk
  7. Immediate emergency management - monitoring, antiplatelets, anticoagulation, anti-ischemic treatment
  8. STEMI reperfusion - primary PCI versus fibrinolysis, timings, contraindications
  9. NSTEMI and unstable-angina management - invasive versus conservative strategy
  10. Drug classes in ACS - aspirin, P2Y12 inhibitors, heparins, statins, beta-blockers, nitrates, ACE inhibitors
  11. Complications - arrhythmias, cardiogenic shock, heart failure, mechanical complications, pericarditis
  12. Special situations - right-ventricular MI, posterior MI, older adults, pregnancy, chronic kidney disease, cocaine-associated ACS
  13. Secondary prevention and discharge planning
  14. High-yield tables, algorithms, and exam-style questions
High-level approach: Treat ACS as a time-critical emergency. Obtain a 12-lead ECG promptly, perform serial high-sensitivity troponin testing, give antiplatelet therapy unless contraindicated, and decide rapidly whether immediate coronary reperfusion is needed. STEMI usually requires urgent reperfusion, preferably primary PCI. NSTEMI/unstable angina requires risk-based selection of an early invasive strategy and antithrombotic treatment.
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