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Acute coronary syndrome diagnosis

How diagnosed?
The first step in the diagnostic assessment is to determine whether there is coronary artery disease or chest pain caused by a different and more innocent state. Of all presenting with chest pain to a general practitioner or emergency, caused only 15% heart disease. Of all who are admitted into the hospital because of chest pain, 75% heart disease. The initial assessment, therefore, requires a careful record of the medical history, physical examination, ECG, and usually blood test to measure the amount of certain proteins that is secreted by a heart attack - called cardiac serum markers.

The diagnosis of acute myocardial infarction, including both STEMI and non-STEMI, requires at least two of the following findings:

  • Symptoms of oxygen deficiency on the heart (ischemic symptoms) - persistent chest pain, radiating pain, nausea, vomiting, cold sweats
  • Diagnostic ECG changes
  • Elevated serum markers

In some patients, symptoms of threatening heart attack less typical. They may present with chest pain, for example. With sudden breathing difficulty, discomfort in the arms, fatigue and reduced work capacity. In these patients, the diagnosis may be difficult to set out on medical history alone, although patients may have serious underlying artery.

An overall assessment of the patient's risk for heart disease (male, age, hereditary predisposed, high cholesterol, obesity, diabetes, high blood pressure) and the occurrence of typical ischemia symptoms, characteristic transient ECG changes and elevated serum markers of myocardial damage (troponin, CK-MB ), makes it possible for the physician to identify patients with high risk of developing serious heart attack and died. This assessment is used to prioritize patients for rapid investigation.

What is the prognosis?
Patients with acute coronary syndrome have a severe prognosis, and it is important that the diagnosis is made early so that treatment can be initiated promptly. The risk of heart attack or death is said about. 10% the first month of pain onset in acute coronary syndrome. The prognosis is highly dependent on the artery that is blocked by a blood clot. The risk - and the need for fast processing - is particularly great if it's the first part of the left coronary artery that is blocked. Occlusion of the circulation in this part of the artery is the cause of more than 60% of all deaths from acute myocardial infarction.

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