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Acute Coronary Syndromes: Introduction and Pathophysiologic Classification

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Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Abstract

Several different classifications of acute coronary syndromes (ACS) exist, and most of them are based on the electrocardiogram (ECG). Based on differences in pathophysiology, treatment, and outcome, ACS are classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation MI, and unstable angina. STEMI is the most urgent subtype of ACS, because it is believed to reflect acute ongoing transmural myocardial ischemia caused by acute coronary occlusion. Based on changes in the different parts of the ECG, ACS patients may be classified according to the extent of the ischemic process or myocardial injury, the acuteness of the disease process, and the severity of myocardial ischemia. In the majority of patients, ACS classification is rather straightforward, but some controversial issues remain to be solved in the future. The role of different ACS subtypes regarding choice of medication also needs to be explored more in detail. This chapter reviews pathophysiological mechanisms explaining the different ECG patterns encountered in ACS; the different ECG manifestations are also presented by illustrative figures. Both established guidelines and ECG-based expert reports for the classification of ACS are presented. Unresolved, controversial issues regarding ECG manifestations of ACS are discussed.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Tampere University Hospital and University of Tampere, Medical School, Biokatu 6, 33520, Tampere, Finland

    Kjell Nikus MD, PhD

  2. Section of Cardiology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS BCM620, Houston, TX, 77030, USA

    Yochai Birnbaum MD, FACC, FAHA

Authors
  1. Kjell Nikus MD, PhD
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  2. Yochai Birnbaum MD, FACC, FAHA
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Correspondence to Kjell Nikus MD, PhD .

Editor information

Editors and Affiliations

  1. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Gowraganahalli Jagadeesh

  2. Pharmacology Unit, AIMST University, Bedong, Malaysia

    Pitchai Balakumar

  3. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Khin Maung-U

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Nikus, K., Birnbaum, Y. (2015). Acute Coronary Syndromes: Introduction and Pathophysiologic Classification. In: Jagadeesh, G., Balakumar, P., Maung-U, K. (eds) Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Adis, Cham. https://doi.org/10.1007/978-3-319-15961-4_19

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  • DOI: https://doi.org/10.1007/978-3-319-15961-4_19

  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-15960-7

  • Online ISBN: 978-3-319-15961-4

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