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ADVANCES IN EARLY DIAGNOSTIC TECHNIQUES AND TREATMENT
PLANNING FOR ACUTE CORONARY SYNDROME
Rakhmatova Dilbar Bakhriddinovna
Bukhara State Medical Institute Department of Internal Diseases in Family Medicine
Annotation.
Acute coronary syndrome (ACS) with or without ST-elevation is a diagnosis
established at the stage of initial contact with the patient based on the clinical picture,
electrocardiogram (ECG) data and the level of markers of myocardial necrosis. and is
usually accompanied by complete thrombotic occlusion of the coronary artery requiring
emergency care, including thrombolytic therapy. ACS without ST elevation may be
accompanied by unstable angina and also requires observation and treatment, especially in
patients with atypical symptoms characteristic of the elderly, women, and those with chronic
diseases.
Key words:
Acute coronary syndrome, myocardial necrosis, unstable angina, thrombolytic
therapy, thrombotic occlusion, angina attack, atypical symptoms.
Introduction
Acute coronary syndrome (ACS) is one of the most pressing issues in modern cardiology, as
it is a leading cause of cardiovascular morbidity and mortality. ACS presents in various
clinical forms, which complicates its diagnosis and treatment. In clinical practice, accurate
identification of ACS—particularly distinguishing between ST-segment elevation (STEMI)
and non-ST-segment elevation (NSTEMI)—is crucial for preventing severe complications.
Diagnostic and treatment methods for ACS are constantly evolving, given the highly
individualized nature of each patient’s condition. Therefore, comprehensive medical
evaluation—including electrocardiography (ECG), blood tests, and other diagnostic
procedures—is essential for accurately determining the type of ACS. This, in turn, ensures
the delivery of the most effective treatment.It is well established that ST-elevation ACS
(STEMI) and non-ST-elevation ACS (NSTEMI) have different clinical presentations and
outcomes. Consequently, the diagnostic and therapeutic approaches must be tailored to the
specific features of each patient’s condition. The aim of this analysis is to review the various
forms of ACS and the key considerations necessary for their management.
Objective of the Study:
To conduct early diagnosis of ST-segment elevation acute coronary syndrome (STEMI) in
order to restore coronary blood flow and reduce the risk of death.
Materials and Methods:
Clinical, laboratory, and instrumental studies were conducted on patients with acute
coronary syndrome at the Bukhara branch of the Republican Scientific Center for
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Emergency Medical Care. The study included patients who sought emergency medical
assistance or were admitted for hospitalization.
To prevent complications of acute myocardial infarction (AMI) and sudden coronary death,
patients with clinical signs of AMI in the pre-hospital stage received thrombolytic therapy
during the first hours after diagnosis confirmation of ST-segment elevation ACS (based on
ECG data within 3–6 hours). This intervention aimed to restore coronary artery function by
resolving thrombotic obstruction.
Using the above methods, clinical indicators and treatment effectiveness rates were
compared between two groups of 60 patients each in Bukhara region:
One group received pre-hospital treatment (via reomobile or shock room);
The other group was treated in intensive care and cardio-therapeutic resuscitation
units of an emergency hospital.
Study Results
Patients with suspected acute coronary syndrome were immediately hospitalized in the
intensive care unit by specialized cardiology emergency teams.
Table 1
NUMBER
OF
PATIENTS
WITH
ACUTE
CORONARY
SYNDROME
HOSPITALIZED AT THE BUKHARA BRANCH OF THE REPUBLICAN
SCIENTIFIC CENTER FOR EMERGENCY MEDICAL CARE
Control
group
(n=20)
Self-admitted,
by
personal
visit
–
25%
Admitted by emergency medical service (EMS) physicians
– 75%
Main
group
(n=60)
Self-admitted,
by
personal
visit
–
25%
Admitted by emergency medical service (EMS) physicians
– 75%
Legend:
Self-admitted
(by
personal
request)
By EMS physicians
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Group
By EMS Physicians Self-Admitted
Main Group (n=60)
45 patients
15 patients
Control Group (n=20)
15 patients
5 patients
Legend:
By EMS physicians
Self-admitted (upon personal request)
Sixty patients were admitted with a diagnosis of acute coronary syndrome (ACS) by
intensive care emergency teams to the shock unit of the Bukhara branch of the Republican
Scientific Center for Emergency Medical Care (RSCEMC). Additionally, 20 patients were
hospitalized on a self-admission basis after undergoing electrocardiography (ECG) and
interpretation of the results.
Emergency measures were focused on relieving pain syndrome, reducing myocardial
workload and oxygen demand, limiting the extent of necrosis in cases of myocardial
infarction, and treating as well as preventing complications such as cardiogenic shock and
life-threatening arrhythmias.
Group
Self-Admitted Admitted by EMS Physicians
Main group
~15 patients
~45 patients
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Group
Self-Admitted Admitted by EMS Physicians
Control group
~5 patients
~15 patients
Legend:
Self-admitted
By emergency medical service (EMS) physicians
Fig. 1. Number of patients with acute coronary syndrome hospitalized at the Bukhara
Branch of the Republican Scientific Center for Emergency Medical Care.
Table 2
Patient Visits by Nature of Chest Pain
Based on Table 2 and Figure 2, the patients' reasons for seeking medical attention—
specifically pain location, character, cause, and time of onset—indicate the urgency and
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necessity of providing emergency care, including pre-hospital first aid. According to survey
data, 100% of respondents accurately described the
character of the pain
and the
time of
its onset
.
In terms of
pain location
, 55 patients (92%) reported radiating pain in the
chest area
,
under the scapula
, and
shoulder
, consistent with classic symptoms of acute coronary
syndrome. A small proportion of elderly patients—5 individuals (8%)—localized pain in the
epigastric region
, which they associated with gastrointestinal discomfort or eating. The
causes of pain
varied and included stress, physical exertion, general malaise, and heavy
lifting—reported by 50 patients (84%).These findings highlight the critical importance of
accurate pain assessment during the early, pre-hospital phase in guiding timely emergency
intervention.
Figure 3. Distribution of Chest Pain Characteristics Among Patients with ACS (Main
vs. Control Group)
Pain Parameter Main Group (%) Control Group (%)
Epigastric Pain
8%
15%
Pain Character
100%
100%
Pain Cause
84%
75%
Pain Onset Time
100%
70%
Legend:
Main group
Control group
Interpretation:
As shown in Fig. 3, both groups demonstrated full awareness (100%) of pain character and
onset time, which is crucial for early diagnosis and pre-hospital emergency care. However,
epigastric pain was more frequently misattributed by elderly patients in the control group.
The main group showed slightly higher recognition of pain causes (84%) compared to the
control group (75%).
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Fig. 2. Reasons for Seeking Medical Attention in Patients with Chest Pain
Table 3. Additional Complaints in Patients with Chest Pain
Previous myocardial infarction
Pain reduced after nitroglycerin use
Shock
⚫
Patient condition: coma
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According to Table 3 and patient questionnaires,
15 patients (25%)
in the main group were
in a state of
shock
, compared to
2 patients (10%)
in the control group. The use of
nitroglycerin
did
not relieve chest pain
in patients from the main group, which supports
the accuracy of the initial diagnosis. In contrast,
3 patients (15%)
in the control group
experienced pain relief after nitroglycerin administration. A
history of myocardial
infarction
was identified based on interviews with relatives:
7 patients (12%)
in the main
group and
1 patient (5%)
in the control group had previously experienced a myocardial
infarction.
Previous Myocardial
Infarction
Pain
Reduced
After
Nitroglycerin
Shock
Figure 4. Clinical Status Indicators in ACS Patients (Main vs. Control Group)
Indicator
Main Group (%) Control Group (%)
Shock
25%
10%
Pain Reduced with Nitroglycerin
0%
15%
Previous Myocardial Infarction
12%
5%
Legend:
Main Group
Control Group
Figure 3. Additional Complaints in Patients with Chest Pain
Table 4. Heredity and Harmful Habits
N
o
.
Main group
Control group
n=60
%
n=20
%
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1
Hereditary
diseases:
Arterial
hypertension
Diabetes mellitus
0
41
9
0
68
15
0
10
3
0
50
15
2
Bad habits: smoking, alcoholic drinks
0
21
22
35
37
0
9
13
45
65
3
Chronic diseases:
Fatty hepatosis
Chronic cholecystitis
Chronic gastritis
Hypertension
Diabetes mellitus
0
0
1
2
5
41
9
0
1.6
3.3
8.3
68
15
0
1
1
1
10
3
5
5
5
50
15
According to Table 4, hereditary factors played a significant role in 41 patients (68%),
primarily those suffering from hypertension. Additionally, 9 patients (15%) had diabetes
mellitus, while other comorbidities such as fatty liver disease (1.6%), chronic hepatitis
(3.3%), and chronic gastritis (8.3%) further worsened the overall condition of the patients.
Harmful habits were also found to be important contributing factors: 21 patients (35%) were
smokers, and 22 patients (37%) reported alcohol consumption.
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Condition
Main Group Control Group
Hypertension
68%
50%
Diabetes Mellitus
15%
~12%
Fatty Liver Disease 1.6%
~1%
Chronic Cholecystitis ~3%
~3%
Chronic Gastritis
8.3%
~7%
Legend:
Main
Group
Control Group
Figure 4. Heredity and Harmful Habits
Table 5. The Influence of BMI and Nutrition in Patients with Acute Coronary
Syndrome (ACS)
No.
Main group
Control group
n=60
%
n=20
%
1.
BMI: normal
Overweight
Obesity 1-2 degrees
13
35
12
22
58
20
2
17
1
10
85
5
2.
Nutrition: fatty
Not greasy
37
23
62
38
15
5
75
25
3.
Gender: male
women
36
24
60
40
15
5
75
25
4.
Age: 40-59 years
60-79 years old
33
27
55
45
13
7
65
35
Analysis Based on Table and Figure 5
The data presented in Table and Figure 5 clearly indicate that 35 patients (58%) had excess
div weight
,
and 12 patients (20%) were diagnosed with Grade I–II obesity
,
while only 13
patients (22%) had a normal div mass index (BMI)
.
Dietary habits revealed that a majority
of respondents—37 patients (62%)
—
regularly consumed fatty foods
,
while only 24 patients
(38%) reported a lower preference for such dishes. This dietary factor is considered
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significant in the development of acute coronary syndrome (ACS). In terms of gender
distribution, the pathology was more prevalent among men (36 patients, 60%) than women
(24 patients, 40%)
.
According to the age classification of the World Health Organization
(WHO), the condition was more common among the young (18–44 years) and middle-aged
(45–59 years) population. Specifically, 33 patients (55%) were in the 40–59 age range,
compared
to
27 patients (45%) aged 60–79 (elderly and senile age categories).
Normal
Overweight
Obesity Grade I–II
Main Group
22% 58% 20%
Control Group
10% 85% 5%
Figure 5a. Impact of Body Mass Index (BMI)
Group Fatty Foods (%) Non-Fatty Foods (%)
Main Group
62% 38%
Control Group
75% 25%
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Fatty
Non-fatty
Diet
Figure 5b. Nutrition in Patients with Acute Coronary Syndrome (ACS)
Group
Men (%) Women (%)
Main Group
60%
40%
Control Group
75%
25%
Legend:
Men
Women
Figure 5c. Gender Distribution in Patients with Acute Coronary Syndrome (ACS)
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Legend:
Ages 40–59
Ages 60–79
Figure 5g. Age Distribution of Patients with Acute Coronary Syndrome (ACS)
For the early diagnosis of ST-segment elevation acute coronary syndrome (STEMI), urgent
interventions are required to relieve chest pain, reduce myocardial workload and oxygen
demand, limit the size of necrosis in the case of myocardial infarction, and to manage and
prevent complications such as shock and life-threatening arrhythmias
.
Shock was observed
in 15 patients (25%) in the main group and in 2 patients (10%) in the control group. No
patients in the main group reported pain relief after nitroglycerin administration
,
which
confirms the accuracy of STEMI diagnosis in this group, while 3 patients (15%) in the
control group did report pain relief.A history of myocardial infarction was confirmed
through interviews with relatives in 7 patients (12%) in the main group and 1 patient (5%) in
the control group.Hereditary factors played a key role, with 41 patients (68%) having a
family history of hypertension
,
9 patients (15%) with diabetes mellitus
,
and other
comorbidities including fatty liver disease (1.6%), chronic hepatitis (3.3%), and chronic
gastritis (8.3%), which contributed to worsening clinical conditions.Harmful habits such as
smoking (21 patients, 35%) and alcohol consumption (22 patients, 37%) were also identified
as important contributing factors.
According to the analysis, 35 patients (58%) were overweight, and 12 patients (20%)
had Grade I–II obesity. Only 13 patients (22%) had a normal div mass index (BMI).
As expected, the majority of patients (37 individuals, 62%) reported regularly consuming
fatty foods, while only 24 patients (38%) had a lower preference for high-fat meals, which is
a notable contributing factor to the development of acute coronary syndrome (ACS). The
condition was more prevalent among men (36 patients, 60%) than women (24 patients,
40%).Based on the World Health Organization (WHO) age classification, the disease
affected primarily the young (18–44 years) and middle-aged (45–59 years) population.
Specifically, 33 patients (55%) were in the 40–59 age group, compared to 27 patients (45%)
aged 60–79 (elderly and senile age categories).
Conclusion
Early diagnosis of ST-segment elevation acute coronary syndrome (STEMI) reveals that the
aforementioned factors play a significant role in predisposing individuals to this pathology.
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