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

  • Veli‐Pekka Harjola
    Emergency Medicine University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital Helsinki Finland
  • John Parissis
    Athens University Hospital Attikon Athens Greece
  • Johann Bauersachs
    Department of Cardiology and Angiology Medical School Hannover Hannover Germany
  • Hans‐Peter Brunner‐La Rocca
    Department of Cardiology Maastricht University Medical Center Maastricht The Netherlands
  • Hector Bueno
    Centro Nacional de Investigaciones Cardiovasculares Madrid Spain
  • Jelena Čelutkienė
    Institute of Clinical Medicine, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine Vilnius University Vilnius Lithuania
  • Ovidiu Chioncel
    University of Medicine Carol Davila/Institute of Emergency for Cardiovascular Disease Bucharest Romania
  • Andrew J.S. Coats
    IRCCS San Raffaele Pisana Rome Italy
  • Sean P. Collins
    Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN USA
  • Rudolf A. de Boer
    Department of Cardiology University of Groningen, University Medical Center Groningen Groningen The Netherlands
  • Gerasimos Filippatos
    Athens University Hospital Attikon Athens Greece
  • Etienne Gayat
    Département d'Anesthésie – Réanimation – SMUR Hôpitaux Universitaires Saint Louis – Lariboisière, INSERM – UMR 942, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot Paris France
  • Loreena Hill
    School of Nursing and Midwifery Queen's University Belfast UK
  • Mika Laine
    Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
  • Johan Lassus
    Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
  • Jyri Lommi
    Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
  • Josep Masip
    Consorci Sanitari Integral University of Barcelona Barcelona Spain
  • Alexandre Mebazaa
    Département d'Anesthésie – Réanimation – SMUR Hôpitaux Universitaires Saint Louis – Lariboisière, INSERM – UMR 942, Assistance Publique – Hôpitaux de Paris, Université Paris Diderot Paris France
  • Marco Metra
    Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia Italy
  • Òscar Miró
    Emergency Department Hospital Clínic, University of Barcelona Catalonia Spain
  • Andrea Mortara
    Department of Cardiology Policlinico di Monza Monza Italy
  • Christian Mueller
    Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University of Basel, University Hospital Basel Basel Switzerland
  • Wilfried Mullens
    Department of Cardiology Ziekenhuis Oost Limburg, Genk – Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University Diepenbeek Belgium
  • W. Frank Peacock
    Henry JN Taub Department of Emergency Medicine Baylor College of Medicine Houston TX USA
  • Markku Pentikäinen
    Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
  • Massimo F. Piepoli
    Heart Failure Unit Cardiology, G. da Saliceto Hospital Piacenza Italy
  • Effie Polyzogopoulou
    Athens University Hospital Attikon Athens Greece
  • Alain Rudiger
    Cardio‐Surgical Intensive Care Unit University and University Hospital Zurich Zurich Switzerland
  • Frank Ruschitzka
    University Heart Center University Hospital Zurich Zurich Switzerland
  • Petar Seferovic
    Department of Internal Medicine Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center Belgrade Serbia
  • Alessandro Sionis
    Cardiology Department Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
  • John R. Teerlink
    Section of Cardiology San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco CA USA
  • Thomas Thum
    Institute of Molecular and Translational Therapeutic Strategies (IMTTS) Hannover Medical School Hannover Germany
  • Marjut Varpula
    Cardiology, Heart and Lung Center University of Helsinki, Helsinki University Hospital Helsinki Finland
  • Jean Marc Weinstein
    Cardiology Division Soroka University Medical Centre Beer‐Sheva Israel
  • Mehmet B. Yilmaz
    Department of Cardiology Cumhuriyet University Faculty of Medicine Sivas Turkey

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<jats:title>Abstract</jats:title><jats:p>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.</jats:p>

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