David Berg, MD, MPH: Evaluation, Management of Acute Coronary Syndrome

Encompassing ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina, acute coronary syndrome is a manifestation of coronary heart disease that typically requires prompt treatment to restore blood flow to the heart.

In his session at the 2024 American College of Physicians (ACP) Internal Medicine meeting in Boston, David Berg, MD, MPH, assistant professor of medicine at Harvard Medical School and cardiologist at Brigham and Women's Hospital, addressed key considerations for the evaluation, diagnosis, and management of acute coronary syndrome.

“One of the fun things about taking care of patients with acute coronary syndromes is this is still a situation where I think a good history really matters,” Berg said in an interview with HCPLive, explaining how he often emphasizes the importance of taking a good history to internists who are caring for patients with acute coronary syndromes.

Specifically, he cited the importance of considering things like the type of chest pain the patient is experiencing, if it is associated with other symptoms like nausea or diaphoresis, and whether the pain feels like a prior myocardial infarction. The core diagnosis, however, comes down to the evaluation of patients’ ECG and assessment of cardiac biomarkers.

“I'm looking for ST segment abnormalities to suggest an acute current of injury, I'm looking for evidence of Q waves to suggest a prior infarct, and then I'm often looking for whether there is a myocardial distribution that is suggested by the pattern of ischemic changes,” Berg explained, going on to describe the use of elevated cardiac biomarkers to establish an MI diagnosis and how that process has improved with refinement in analytic technologies over the last 15 years, further mentioning “enormous progress” in the field of acute coronary syndromes in the past 40 years.

Berg also highlighted several medical therapies that serve as contemporary standard of care, including anti-ischemic therapy to reduce myocardial oxygen demand and reduce myocardial injury as a consequence of ischemia, principal therapies focused on trying to open the infarct-related artery, as well as antiplatelet and anticoagulant therapies.

Berg has relevant disclosures with AstraZeneca, Pfizer, Mobility Bio, Youngene Therapeutics, and Kowa Company.