Fast Five Quiz: Test Your Knowledge of Acute Coronary Syndrome

Yasmine S. Ali, MD

Disclosures

April 26, 2017

Evidence suggests that women have atypical symptoms more often than men, which may explain the frequent failure of clinicians to initially diagnose ACS in women. However, typical symptoms remain the strongest symptom predictors of ACS in women and are equally important in women as in men.

A summary of patient complaints is as follows:

  • Palpitations

  • Pain (usually described as pressure, squeezing, or a burning sensation across the precordium and may radiate to the neck, shoulder, jaw, back, upper abdomen, or either arm)

  • Exertional dyspnea

  • Diaphoresis from sympathetic discharge

  • Nausea from vagal stimulation

  • Decreased exercise tolerance

Physical findings can vary from normal to any of the following:

  • Hypotension: Indicates ventricular dysfunction due to myocardial ischemia, infarction, or acute valvular dysfunction

  • Hypertension: May precipitate angina or reflect elevated catecholamine levels due to anxiety or to exogenous sympathomimetic stimulation

  • Diaphoresis

  • Pulmonary edema and other signs of left heart failure

  • Extracardiac vascular disease

  • Jugular venous distention

  • Cool, clammy skin and diaphoresis in patients with cardiogenic shock

Rales or crackles on pulmonary examination may suggest left ventricular dysfunction or mitral regurgitation.

For more on the presentation of ACS, read here.

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