Acute Coronary Syndrome

Coronary artery disease is the leading cause of death in the United States. Acute coronary syndrome is a medical emergency that complicates coronary artery disease. This edition of FP Essentials^TM will address four advances in the management of acute coronary syndrome: management of ST-segment elevation myocardial infarction (MI); management of non-ST-segment elevation MI; management of unstable angina; and outpatient recommendations and follow-up after acute coronary syndrome.

The FP Essentials^TM monograph should be approximately 10,000 words in length, divided into four sections of approximately 2,500 words each, plus a preface, key practice recommendations, a maximum of 15 tables and figures, recommended readings, and references. The monograph should focus on what’s new in each topic and should answer the key questions listed for each section. Each section should begin with an illustrative case, similar to the examples provided, with modifications to emphasize key points. The references listed below include information that should be considered in preparation of this edition of FP Essentials^TM. However, these references are only a useful starting point that should be used to identify additional information to review.

Example case: Michael is a 60-year-old white man with a history of smoking, diabetes, hypertension, and hyperlipidemia, who developed crushing chest pressure while eating dinner. He was transported to the emergency department, where an electrocardiogram revealed 3-mm ST-segment elevations in leads V₂ through V₄. He was taken to the cardiac catheterization department where a 95% occlusion of the mid-left anterior descending artery was identified, which responded well to angioplasty and coronary stent placement.

Key questions to consider:

Example case: Alice is a 50-year-old woman with hypertension and diabetes who presents to the emergency department with 3 hours of severe indigestion and nausea. She is hemodynamically stable, and results of the physical examination are normal. The electrocardiogram reveals 1 mm flat ST depressions with T wave inversions in leads II, III, and aVF. Laboratory results are remarkable for a troponin I that is elevated to 0.7 ng/mL.

Key questions to consider:

Example case: Susan is a 60-year-old black woman with a history of stable angina who has been experiencing more frequent episodes of angina at lower levels of exertion. She usually develops substernal pressure, which is relieved with inactivity, after walking 10 blocks. Over the past 3 days, she has noticed that she develops more severe chest pressure with shortness of breath after walking 20 yards. She presents to your office for evaluation. An electrocardiogram at rest reveals a normal sinus rhythm, a heart rate of 80 bpm, and nonspecific ST-segment elevation and T-wave changes.

Key questions to consider:

Example case: Jeremiah is a 50-year-old white man with a history of diabetes and hypertension who was admitted to the hospital with a non-ST-segment elevation myocardial infarction (NSTEMI). He underwent percutaneous coronary intervention with a drug-eluting stent placed in the first diagonal artery. He has done well post-revascularization and is ready for discharge. He asks you what he can expect for follow-up of his condition over the next 6 months.

Key questions to consider: