Management of Acute Coronary Syndrome in Patients With Liver Cirrhosis

Taha Ahmed; Alla Y. Grigorian; Adrian W. Messerli


Am J Cardiovasc Drugs. 2022;22(1):55-67. 

In This Article

Diagnosis of ACS in LC

ACS is a time-dependent medical emergency; it requires prompt recognition and risk stratification to ensure rapid institution of appropriate management. Cardiac biomarkers should be measured as soon as ACS is suspected and serial electrocardiograms (ECGs) performed concurrently. The spectrum of ACS encompasses one of the following three entities: STEMI, NSTEMI, and unstable angina. STEMI is characterized by the complete occlusion of the lumen, with resultant symptoms of myocardial ischemia accompanied by a persistent elevation of the ST segment on the ECG and the subsequent release of biomarkers of myocardial necrosis. It remains a medical emergency, where rapid revascularization, either by fibrinolytic administration or mechanical intervention, is mandated. An NSTEMI may be caused by partial or complete occlusion of a coronary artery, demand ischemia, or coronary vasospasm; it is defined by ischemic ECG changes and elevated cardiac biomarkers. Unstable angina is caused by a non-occlusive coronary thrombus formation, which allows for dynamic ischemic ECG changes, but not necessarily biomarker elevations. All patients who suffer from an ACS are candidates for several cardio-protective medications. The diagnostic gold standard is invasive coronary angiography, a minimally invasive procedure serving diagnostic and therapeutic purposes, although the procedure may not be indicated in every patient.[15]