188 Chapter 8 18. Acute Coronary Syndrome with elevated troponin levels Includes all patients with unstable ischemic heart disease, including non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI) and unstable angina pectoris. Please assign this diagnostic label when the following criteria apply: • The patient has a history of ischemic heart disease and experiences in rest or during limited exercise chest pain (with radiation to neck, jaw, left arm), and/or less typical symptoms: dyspnea, nausea/vomiting, fatigue, palpitations, syncope AND • At Academic Medical Center: elevated troponin levels: troponin levels >0.05µg/L at ED presentation, or >50% increase of the second troponin measurement compared to troponin levels at ED presentation OR • At Spaarne Gasthuis: elevated troponin levels: troponin levels ≥70ng/L at ED presentation, or >100ng/L increase of the second troponin measurement compared to troponin levels at ED presentation. NB: demand ischemia or type 2 ischemia should be labeled “Other thoracic pathology”. References: [15, 16] 19. Acute Coronary Syndrome without elevated troponin levels Includes all other patients with unstable ischemic heart disease, including non-STelevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI) and unstable angina pectoris. Please assign this diagnostic label when the following criteria apply: • The patient has a history of ischemic heart disease and experience in rest or during limited exercise chest pain (with radiation to neck, jaw, left arm), and/or less typical symptoms: dyspnea, nausea/vomiting, fatigue, palpitations, syncope References: [15, 16] 20. Stable angina pectoris The patient has classical symptoms of angina pectoris: • Retrosternal complaints • Complaints provoked by exercise or emotion • Relief of complaints by rest or nitroglycerine Exception: • When “stable angina pectoris” is not explicitly mentioned in the ED report, but treatment with isosorbide mononitrate was started, strongly consider this diagnostic label. When in doubt, refer this case to the Adjudication Committee. References: [17] 21. Cardiac failure The patient has at least one of the following symptoms:
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