Part 10: Acute Coronary Syndromes
2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
The 2010 AHA Guidelines for CPR and ECC for the evaluation and management of acute coronary syndromes (ACS) are intended to define the scope of training for healthcare providers who treat patients with suspected or definite ACS within the first hours after onset of symptoms. These guidelines summarize key out-of-hospital, emergency department (ED), and related initial critical-care topics that are relevant to diagnosis and initial stabilization and are not intended to guide treatment beyond the ED. Emergency providers should use these contents to supplement other recommendations from the ACC/AHA Guidelines, which are used throughout the United States and Canada.1–3 As with any guidelines, these general recommendations must be considered within the context of local resources and their application to individual patients by knowledgeable healthcare providers. The healthcare providers managing the individual patients are best suited to determine the most appropriate treatment strategy.
The primary goals of therapy for patients with ACS are to
Reduce the amount of myocardial necrosis that occurs in patients with acute myocardial infarction (AMI), thus preserving left ventricular (LV) function, preventing heart failure, and limiting other cardiovascular complications
Prevent major adverse cardiac events (MACE): death, nonfatal MI, and need for urgent revascularization
Treat acute, life-threatening complications of ACS, such as ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), unstable tachycardias, symptomatic bradycardias (See Part 8: “Advanced Cardiovascular Life Support”), pulmonary edema, cardiogenic shock and mechanical complications of AMI
An overview of recommended care for the ACS patient is illustrated in Figure 1, the Acute Coronary Syndromes Algorithm. Part 10 provides details of the care highlighted in the numbered algorithm boxes; box numbers in the text correspond to the numbered boxes in the algorithm. In this part, the abbreviation “AMI” refers to acute myocardial infarction, whether associated with ST-elevation myocardial infarction (STEMI) or non-ST-elevation …