Acute coronary syndrome.

Acute coronary syndrome is a complex of pathophysiological reactions. This disease includes acute myocardial infarction (both in general, and in the case of the development of private forms - with or without an upsurge of the ST segment), as well as unstable angina.

Thus, it can be said that acute coronary syndrome, the definition of which was given above, is not just a disease, but rather a complex concept that unites a broad group of cardiovascular pathology with its typical manifestations (infarctions and angina pectoris).

The symptomatology of ACS is nothing more than the symptomatology of this particular pathology. That is, it is characterized by all the features of the underlying disease. However, there are some common symptoms that manifest the majority of acute diseases of the cardiovascular system. Among these manifestations, the leading place, both in frequency of occurrence, and in strength of manifestation, is painful . Acute coronary syndrome, as a rule, is manifested by strong stitching, cutting or even burning pain behind the sternum in the region of the heart. The pain is poorly controlled by the intake of nitroglycerin or is practically not docked. Typically, the painful attack takes more than 15 minutes. For people with angina characterized by the destabilization of the disease (increased pain, as well as an increase in their duration, the lack of response to the use of nitroglycerin). Persons of twenty-five to forty years old, as well as elderly people (over seventy years old), can have atypical pain localization - pleural, epigastric and others. Occasionally, there are no painless forms, which are manifested by causeless shortness of breath, a disorder of the gastrointestinal tract.

Acute coronary syndrome can be identified by the following diagnostic manipulations:

- Physical examination (that is, collecting anamnesis and examining the patient, performing palpation, percussion and other measures)

- recording of the electrocardiogram to confirm cardiac pathology and exclusion of other diseases (ECG shows signs of ischemia of the muscle tissue of the heart - lifting "ST" or "T" over the isoline)

- detection of biochemical markers of damage to the heart muscle - tropomyosin and troponin, as well as the determination of elevated levels of creatine phosphokinase in the fraction of MB and myoglobin.

- performing the manipulation of echocardiography, according to the results of which the functional disorders in the heart are judged (the level of violation of the systolic function of the heart)

In addition to basic studies, acute coronary syndrome can be confirmed and carried out additional, third-party methods, such as coronary angiography and Holter monitoring. Coronarography is performed to confirm the pathology of the vascular bed in the muscle tissue of the heart. Holter monitoring is used to detect acute (non-permanent and short-term) disorders in the work of the heart by recording the ECG for one or several days. Most often with the help of this method, transient cardiac arrhythmias - extrasystole - are detected.

The similarity of symptoms and some difficulties in carrying out and interpreting the physical and laboratory methods of research create the prerequisites for an in-depth study of differential diagnosis.

Such diagnostics of acute coronary syndrome is performed with pulmonary embolism, pericarditis, aortic aneurysm (in particular, with its delamination), hypothyroidism and myocarditis of infectious etiology.

Acute coronary syndrome. Treatment of this condition is carried out, mainly using nitroglycerin (to expand the vascular bed in the muscle tissue of the heart), aspirin ( to dilute blood and reduce the ischemia site), B-blockers (atenolol, metoprolol). In addition, with high blood pressure values, antihypertensive therapy is performed.