The term acute coronary syndrome (ACS) refers to a variety of conditions that result in sudden, reduced blood flow to the heart. These conditions include unstable angina and heart attacks. When heart tissue is damaged or destroyed, a heart attack occurs. An unstable angina occurs when blood flow to the heart decreases, but it is not severe enough to cause cell death or a heart attack. However, a reduced blood flow can increase your risk of a heart attack.
Treatment aims to improve blood flow, treat complications, and prevent future problems caused by acute coronary syndrome. Acute coronary syndrome usually causes severe chest pain or discomfort.
The acute coronary syndrome is usually caused by fatty deposits on the walls of blood vessels that supply blood, oxygen, and nutrients to the heart. These deposits are called plaques. Coronary arteries supply the heart with blood.
When a fatty deposit ruptures or splits, a blood clot forms. Blood cannot flow to heart muscles because this clot blocks it. When the supply of oxygen to heart muscles is too low, cells can die, resulting in muscle damage. It is called a heart attack when these cells die.
When there is no cell death, the drop in oxygen still results in heart muscles that don't work correctly. This change may be temporary or permanent.
The symptoms of acute coronary syndrome usually begin suddenly and depend on age, sex and pre-existing conditions like high blood pressure, diabetes and lifestyle.
The most common symptom is chest pain or discomfort. This is often described as aching, pressure, tightness or burning.
Chest pain also can spread to other parts of the body, such as:
Shoulders
Arms
Upper belly area
Back
Neck
Jaw
Other symptoms may include:
Nausea or vomiting
Indigestion
Shortness of breath
Sudden, heavy sweating
Racing heartbeat
Feeling lightheaded or dizzy
Fainting
Unusual fatigue
Chest pain or discomfort is the most common symptom but symptoms may vary quite a bit depending on your age, sex and other medical conditions.
You’re more likely to have symptoms without chest pain or discomfort if you’re a woman, an older adult or have diabetes.
Acute coronary syndrome is an emergency that requires immediate attention. Chest pain or discomfort can be a symptom of many life-threatening conditions.
To diagnose ACS, your healthcare provider will perform a physical exam, ask you about your symptoms and medical history, and order some tests. Some of the tests that can help diagnose ACS are:
An electrocardiogram (ECG or EKG) measures the electrical activity of your heart and can detect changes in your heartbeat that indicate a decreased blood flow or damage to your heart.
These tests can detect certain proteins that leak into the blood after a heart attack or unstable angina. They can also measure your blood sugar, cholesterol, and other factors that contribute to ACS.
It shows how well your blood flows through your coronary arteries. It can reveal blockages or narrowings in the arteries that supply blood to your heart.
Using sound waves, an echocardiogram shows how your heart pumps blood and if there is any damage to the heart muscle.
A myocardial perfusion imaging test uses radioactive material to show how well blood reaches different parts of the heart muscle. It can detect areas of poor blood flow or damage to the heart.
A computerized tomography (CT) angiogram shows your coronary arteries in greater detail than an angiogram because it uses X-rays and a computer.
Exercise stress test: Measures how well your heart works when you exercise on a treadmill, bike, or rower while being monitored by an ECG machine.
A healthcare provider will use the results of these tests to determine the type of ACS you have (unstable angina, non-ST-elevation myocardial infarction, or ST-elevation myocardial infarction) and what treatment options are best for you.
The treatment for acute coronary syndrome aims to relieve pain, restore normal blood flow to your heart and reduce your risk of future problems.
The treatment options depend on whether you have unstable angina or a non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI).
If you have unstable angina, you will be given:
Aspirin (a type of anti-inflammatory drug) within 30 minutes of noticing symptoms.
Nitroglycerin (a medication that widens your blood vessels) if you have chest pain.
Oxygen through a mask if you have trouble breathing.
Medications such as clopidogrel (an antiplatelet drug), beta blockers (drugs that lower your heart rate and blood pressure), ACE inhibitors (drugs that improve blood flow), ARBs (drugs that lower blood pressure) and statins (drugs that lower cholesterol).
Lifestyle changes such as quitting smoking, eating healthy foods, exercising regularly and managing stress.
If you have NSTEMI or STEMI, you will be taken to an emergency department for further evaluation and treatment. You may need:
A coronary angiogram to see if there are any blockages in your arteries.
A percutaneous coronary intervention (PCI) to open up the blocked artery with a balloon or a stent.
A coronary artery bypass grafting (CABG) surgery to create a new route for blood flow around the blocked artery.
Additionally, you may receive medications to treat complications such as arrhythmias (irregular heartbeat), heart failure or kidney disease. These medications include aspirin, nitroglycerin, oxygen, clopidogrel, beta blockers, ACE inhibitors, ARBs, and statins.
The prevention of acute coronary syndrome involves reducing your risk factors for coronary artery disease. These include:
Quitting smoking
Eating a healthy diet that is low in sodium, fat and cholesterol
Increasing physical activity
Maintaining a healthy weight
Managing stress
Controlling your blood pressure, cholesterol and blood sugar levels
Taking medications as prescribed by your doctor
You should also follow up with your doctor regularly and get screened for any signs of heart disease. If you have any symptoms of acute coronary syndrome, seek medical attention immediately.
