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Acute coronary syndromes and acute heart failure: a diagnostic dilemma and high-risk combination. A statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology.

  • Harjola VP Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
  • Parissis J Athens University Hospital Attikon, Athens, Greece.
  • Bauersachs J Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany.
  • Brunner-La Rocca HP Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
  • Bueno H Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
  • Čelutkienė J Institute of Clinical Medicine, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
  • Chioncel O University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease, Bucharest, Romania.
  • Coats AJS IRCCS, San Raffaele Pisana, Rome, Italy.
  • Collins SP Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
  • de Boer RA Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
  • Filippatos G Athens University Hospital Attikon, Athens, Greece.
  • Gayat E Département d'Anesthésie - Réanimation - SMUR, Hôpitaux Universitaires Saint Louis - Lariboisière, INSERM - UMR 942, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France.
  • Hill L School of Nursing and Midwifery, Queen's University, Belfast, UK.
  • Laine M Cardiology, Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
  • Lassus J Cardiology, Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
  • Lommi J Cardiology, Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
  • Masip J Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.
  • Mebazaa A Département d'Anesthésie - Réanimation - SMUR, Hôpitaux Universitaires Saint Louis - Lariboisière, INSERM - UMR 942, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, Paris, France.
  • Metra M Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • Miró Ò Emergency Department, Hospital Clínic, University of Barcelona, Catalonia, Spain.
  • Mortara A Department of Cardiology, Policlinico di Monza, Monza, Italy.
  • Mueller C Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University of Basel, University Hospital Basel, Basel, Switzerland.
  • Mullens W Department of Cardiology, Ziekenhuis Oost Limburg, Genk - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
  • Peacock WF Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA.
  • Pentikäinen M Cardiology, Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
  • Piepoli MF Heart Failure Unit, Cardiology, G. da Saliceto Hospital, Piacenza, Italy.
  • Polyzogopoulou E Athens University Hospital Attikon, Athens, Greece.
  • Rudiger A Cardio-Surgical Intensive Care Unit, University and University Hospital Zurich, Zurich, Switzerland.
  • Ruschitzka F University Heart Center, University Hospital Zurich, Zurich, Switzerland.
  • Seferovic P Department of Internal Medicine, Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia.
  • Sionis A Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Teerlink JR Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, CA, USA.
  • Thum T Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.
  • Varpula M Cardiology, Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
  • Weinstein JM Cardiology Division, Soroka University Medical Centre, Beer-Sheva, Israel.
  • Yilmaz MB Department of Cardiology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey.
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  • 2020-04-30
Published in:
  • European journal of heart failure. - 2020
Acute coronary syndrome
Acute heart failure
Clinical scenario
Diagnosis
Management
Myocardial infarction
Myocardial injury
Troponins
English Acute coronary syndrome is a precipitant of acute heart failure in a substantial proportion of cases, and the presence of both conditions is associated with a higher risk of short-term mortality compared to acute coronary syndrome alone. The diagnosis of acute coronary syndrome in the setting of acute heart failure can be challenging. Patients may present with atypical or absent chest pain, electrocardiograms can be confounded by pre-existing abnormalities, and cardiac biomarkers are frequently elevated in patients with chronic or acute heart failure, independently of acute coronary syndrome. It is important to distinguish transient or limited myocardial injury from primary myocardial infarction due to vascular events in patients presenting with acute heart failure. This paper outlines various clinical scenarios to help differentiate between these conditions and aims to provide clinicians with tools to aid in the recognition of acute coronary syndrome as a cause of acute heart failure. Interpretation of electrocardiogram and biomarker findings, and imaging techniques that may be helpful in the diagnostic work-up are described. Guidelines recommend an immediate invasive strategy for patients with acute heart failure and acute coronary syndrome, regardless of electrocardiographic or biomarker findings. Pharmacological management of patients with acute coronary syndrome and acute heart failure should follow guidelines for each of these syndromes, with priority given to time-sensitive therapies for both. Studies conducted specifically in patients with the combination of acute coronary syndrome and acute heart failure are needed to better define the management of these patients.
Language
  • English
Open access status
bronze
Identifiers
Persistent URL
https://sonar.ch/global/documents/121553
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