Acute Coronary Syndrome: Common Complications and Conditions That Mimic ACS.

Complications after acute myocardial infarction (MI) can be serious and potentially life-threatening. Coronary reperfusion therapy and revascularization can reduce the risk of these complications, but they still occur. Arrhythmias and conduction abnormalities are among the most common complications, and occur most often in hemodynamically unstable patients. Patients with ventricular arrhythmias should be treated with beta blockers and sometimes amiodarone, along with cardioversion and defibrillation if unresponsive to medical therapy. Patients with bradyarrhythmias initially can be treated with atropine but may need pacemaker therapy. Atrial fibrillation (AF) is managed with standard pharmacotherapy; cardioversion is indicated if the patient is hemodynamically unstable and has persistent AF. Anticoagulation should be started based on the CHA2DS2-VASc score. Cardiogenic shock requires prompt diagnosis with echocardiography and urgent revascularization. Mechanical complications include ventricular aneurysm (managed medically with anticoagulation or surgically if the aneurysm is large), papillary muscle rupture (managed with mitral valve replacement), and ventricular septal rupture (which requires surgical repair). Conditions that mimic acute coronary syndrome (ACS) include cocaine-induced chest pain, pericarditis, myocarditis, coronary artery dissection, and Takotsubo cardiomyopathy. These conditions, each with its own specific diagnostic criteria, should be considered when the clinical picture and test results are not fully consistent with ACS.