Fast Five Quiz: Atrial Fibrillation and Acute Coronary Syndrome

Sandeep K. Goyal, MD


September 17, 2020

Figure 3. Illustration depicting various elements related to acute coronary syndrome: a man in cardiac distress, the heart with coronary artery undergoing stent placement, an ECG, and aspirin.

Patients who come to the emergency department with AF often complain of chest pain, dyspnea, or palpitations in the setting of rapid ventricular rate. Troponin without ischemic injury may be detected in these patients because of a supply and demand mismatch. According to the Third Universal Definition of Myocardial Infarction consensus document, these supply and demand mismatch conditions should not be considered an MI but instead characterized as myocardial injury. Although an elevated troponin level could be considered an NSTEMI, controlling the rapid ventricular rate can reveal the underlying disease and if the patient is on the ACS continuum of care. Astute clinicians should recognize that patients with AF without a primary diagnosis of STEMI or NSTEMI who have elevated levels of troponin and/or ECG readings indicating left ventricular hypertrophy may be at increased risk for ACS, particularly for MI, in the next year. Close follow-up in such cases is essential.

Learn more about ACS complications in patients with AF.


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