TY - JOUR
TI - Acute coronary syndromes and acute heart failure: a diagnostic dilemma
and high-risk combination. A statement from the Acute Heart Failure
Committee of the Heart Failure Association of the European Society of
Cardiology
AU - Harjola, Veli-Pekka
AU - Parissis, John
AU - Bauersachs, Johann and
AU - Brunner-La Rocca, Hans-Peter
AU - Bueno, Hector
AU - Celutkiene, Jelena
AU - and Chioncel, Ovidiu
AU - Coats, Andrew J. S.
AU - Collins, Sean P.
AU - de
AU - Boer, Rudolf A.
AU - Filippatos, Gerasimos
AU - Gayat, Etienne
AU - Hill,
AU - Loreena
AU - Laine, Mika
AU - Lassus, Johan
AU - Lommi, Jyri
AU - Masip,
AU - Josep
AU - Mebazaa, Alexandre
AU - Metra, Marco
AU - Miro, Oscar and
AU - Mortara, Andrea
AU - Mueller, Christian
AU - Mullens, Wilfried and
AU - Peacock, W. Frank
AU - Pentikaeinen, Markku
AU - Piepoli, Massimo F. and
AU - Polyzogopoulou, Effie
AU - Rudiger, Alain
AU - Ruschitzka, Frank and
AU - Seferovic, Petar
AU - Sionis, Alessandro
AU - Teerlink, John R.
AU - Thum,
AU - Thomas
AU - Varpula, Marjut
AU - Weinstein, Jean Marc
AU - Yilmaz, Mehmet
AU - B.
JO - European Journal of Heart Failure
PY - 2020
VL - 22
TODO - 8
SP - 1298-1314
PB - Wiley
SN - null
TODO - 10.1002/ejhf.1831
TODO - Acute coronary syndrome; Acute heart failure; Diagnosis; Management;
Myocardial injury; Myocardial infarction; Troponins; Clinical scenario
TODO - Acute coronary syndrome is a precipitant of acute heart failure in a
substantial proportion of cases, and the presence of both conditions is
associated with a higher risk of short-term mortality compared to acute
coronary syndrome alone. The diagnosis of acute coronary syndrome in the
setting of acute heart failure can be challenging. Patients may present
with atypical or absent chest pain, electrocardiograms can be confounded
by pre-existing abnormalities, and cardiac biomarkers are frequently
elevated in patients with chronic or acute heart failure, independently
of acute coronary syndrome. It is important to distinguish transient or
limited myocardial injury from primary myocardial infarction due to
vascular events in patients presenting with acute heart failure. This
paper outlines various clinical scenarios to help differentiate between
these conditions and aims to provide clinicians with tools to aid in the
recognition of acute coronary syndrome as a cause of acute heart
failure. Interpretation of electrocardiogram and biomarker findings, and
imaging techniques that may be helpful in the diagnostic work-up are
described. Guidelines recommend an immediate invasive strategy for
patients with acute heart failure and acute coronary syndrome,
regardless of electrocardiographic or biomarker findings.
Pharmacological management of patients with acute coronary syndrome and
acute heart failure should follow guidelines for each of these
syndromes, with priority given to time-sensitive therapies for both.
Studies conducted specifically in patients with the combination of acute
coronary syndrome and acute heart failure are needed to better define
the management of these patients.
ER -