Lesson 3: Coronary Artery Disease, Acute Coronary Syndromes and Rehabilitation

Stable angina, ACS presentations, reperfusion principles and follow-up risk reduction.

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Course 03: Cardiovascular, Vascular and Hematology

Lesson 3 of 12. Read the diagnostic framework and case, then complete the 10-question practice set. All material is original educational content; high-risk presentations require emergency referral.

Ischemic syndromes

  • Classical angina is often exertional pressure relieved by rest; dyspnea, epigastric discomfort or fatigue may be ischemic equivalents.
  • ACS includes unstable angina, NSTEMI and STEMI; new rest pain, crescendo symptoms or prolonged discomfort require emergency assessment.
  • Differentiate acute coronary occlusion from pulmonary embolism, aortic dissection, pericarditis, pneumothorax and esophageal causes.
  • Assess symptom onset, prior coronary interventions, antiplatelet use, anticoagulants and bleeding risk.

Initial emergency workup

  • Prompt 12-lead ECG and serial assessment are essential; ST elevation or occlusive patterns mandate immediate reperfusion-pathway activation.
  • Use serial high-sensitivity troponin in a validated algorithm; distinguish acute myocardial injury from type 1 MI using clinical and ECG evidence.
  • Do not use a single normal troponin at symptom onset to rule out infarction.
  • High-risk features include hemodynamic instability, ventricular arrhythmia, ongoing pain, acute HF and dynamic ischemic ECG changes.

Evidence-based treatment principles

  • Emergency teams decide on reperfusion, antithrombotics, hemodynamic support and invasive strategy based on ECG, clinical instability and local protocols.
  • Antiplatelet therapy, lipid lowering and risk-factor management are central after ACS; choice and duration of dual antiplatelet therapy depend on bleeding/ischemic risk.
  • Check contraindications and bleeding risk before antithrombotics; do not administer unreviewed medication in undifferentiated chest pain with possible dissection.
  • Avoid routine oxygen for normoxemic ACS patients; provide oxygen according to clinical need and current resuscitation standards.

Stable CAD and rehabilitation

  • For stable symptoms use symptom assessment, probability-based investigation, antianginal management and referral when symptoms or findings are high risk.
  • Cardiac rehabilitation includes progressive activity, medication education, tobacco cessation, nutrition support and psychosocial assessment.
  • Recurrent chest pain after a recent MI, stent placement or bypass graft requires urgent reassessment; adherence to antiplatelets matters.

Communication

  • Explain why time matters, what ECG/troponin can and cannot tell us, and why emergency transport is preferable to self-driving.
  • Review safety-net symptoms after discharge: new prolonged chest pain, fainting, rapidly progressive dyspnea or severe palpitations.
  • Use shared decisions and document bleeding-risk discussions around antiplatelet treatment.

Applied clinical case

A 67-year-old has 50 minutes of central chest pressure radiating to the left arm. ECG shows new ST elevation in contiguous leads.

Show model clinical reasoning and disposition

Presume STEMI until evaluated by the emergency team; activate the local reperfusion pathway immediately and avoid delays for nonessential investigations.

Clinical self-check

  1. Why does the ECG require urgent action?
  2. Which mimics alter immediate safety?
  3. What is the role of secondary prevention?

Guidelines and further learning

Downloadable study materials

Study this lesson (10 MCQs)Exam mode (25 MCQs)
Practice lesson questions