Margita Belicová
The leading symptom that initiates the diagnostic and therapeutic cascade of acute coronary syndrome is chest pain, but the classification is based on the electrocardiogram. Acute coronary syndrome represent a life-threatening manifestation of atherosclerosis usually precipitated by acute thrombosis , induced by a ruptured or erosed atherosclerotic plaque, with or without concomitant vasoconstriction, causing a sudden and critical reduction in blood flow. Patients with acute coronary syndrome without ST segment elevation represent a heterogenous group with different degree of risk of developing myocardial infarction, death, sudden death and that is why the cornerstone for their prognosis and character of treatment is the risk stratification. The management includes antiischemic agents (beta-blockers, intravenous nitrates, calcium channel blockers), anticoagulants (unfractionated heparin, low molecular weight heparin or fondaparin), antiplatelet agents (aspirin and clopidogrel) and coronary revascularization. Urgent coronary angiography is recommended in patient with refractory or recurrent angina associated with dynamic ST deviation, heart failure, life threatening arrhythmias or haemodynamic instability.