Περίληψη:
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.
Συγγραφείς:
Harjola, Veli-Pekka
Parissis, John
Bauersachs, Johann and
Brunner-La Rocca, Hans-Peter
Bueno, Hector
Celutkiene, Jelena
and Chioncel, Ovidiu
Coats, Andrew J. S.
Collins, Sean P.
de
Boer, Rudolf A.
Filippatos, Gerasimos
Gayat, Etienne
Hill,
Loreena
Laine, Mika
Lassus, Johan
Lommi, Jyri
Masip,
Josep
Mebazaa, Alexandre
Metra, Marco
Miro, Oscar and
Mortara, Andrea
Mueller, Christian
Mullens, Wilfried and
Peacock, W. Frank
Pentikaeinen, Markku
Piepoli, Massimo F. and
Polyzogopoulou, Effie
Rudiger, Alain
Ruschitzka, Frank and
Seferovic, Petar
Sionis, Alessandro
Teerlink, John R.
Thum,
Thomas
Varpula, Marjut
Weinstein, Jean Marc
Yilmaz, Mehmet
B.
