Acute coronary syndrome, or ACS, refers to the syndrome of patients presenting with a history compatible with acute myocardial ischemia. ACS encompasses myocardial infarction (MI), including ST-segment elevation (STEMI) and non-ST segment elevation (NSTEMI) myocardial infarction, as well as unstable angina. A 12-lead electrocardiogram obtained and interpreted within ten minutes of the patient presenting to the emergency department is a vital triage tool to distinguish STEMI from NSTEMI. Ideally, transmission of the ECG directly from the field further minimizes delays in the delivery of appropriate therapy. Obtaining serial cardiac biomarkers may be the only way to distinguish the difference between NSTEMI and unstable angina. Acute coronary syndrome is suggested by the prolonged resting chest discomfort with radiation to the arms. The patient also has a history of exertional chest discomfort that is consistent with angina pectoris, and she has multiple risk factors for coronary artery disease. In many cases, the onset of acute coronary syndrome occurs in the early morning hours and may awaken the patient. Nausea is a common symptom in an acute myocardial infarction, particularly when it involves the inferior wall. Acute coronary syndrome also occurs with atypical symptoms, especially in the elderly or diabetic patient. It is important to recognize that coronary artery disease is the leading cause of death in women.
When caring for women with coronary artery disease, there are some special problems to consider. The signs and symptoms of coronary disease can go unrecognized, both by the patient and the physician. The incidence of coronary artery disease in premenopause is low, but rapidly escalates postmenopause. Women with acute infarctions present later in life than men. They often have atypical symptoms, complaining less of chest discomfort and more of gastrointestinal symptoms, dyspnea and fatigue. The result of these problems in women is longer delays in seeking and receiving treatment. This includes both the control of risk factors and the treatment of symptomatic coronary disease. Women have a higher mortality from acute myocardial infarction compared to men. They also have more complications with interventions including coronary angioplasty and coronary bypass surgery. Contributing factors may include their smaller body mass and older age at presentation.