Clinical assessment of suspected acute coronary syndrome
THE CONTEXT
Acute coronary syndrome may occur in someone with previous stable angina or present as the first manifestation of coronary artery disease.
Presentation and examination
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A previous history of stable angina supports suspicion of acute coronary syndrome, but acute severe chest discomfort at rest can also be the first presentation of coronary artery disease.
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Diagnosis depends on analysing the character of the discomfort and its associated features.
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Examination may reveal signs of coronary artery disease risk factors.
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Pallor or sweating indicates autonomic disturbance and is typical of acute coronary syndrome. Arrhythmia, hypotension and heart failure may also occur.
Differences in symptoms
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Although symptoms overlap considerably between men and women, women are more likely to experience discomfort between the shoulder blades, nausea or vomiting, and breathlessness.
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Women are less likely to experience chest discomfort or sweating.
Urgency
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Symptoms consistent with acute coronary syndrome require immediate hospitalisation and urgent investigation because of the high risk of avoidable complications.