Acute coronary syndrome is a general name given to conditions that occur with a sudden decrease in blood supply to the heart (for example, heart attack). You can find more information below.
What is acute coronary syndrome?
Acute coronary syndrome is a general term for any condition in which blood flow to any part of the heart is suddenly reduced or blocked. It is an emergency that requires immediate treatment. Once diagnosed, the affected person will receive immediate treatment, which may include procedures such as cardiac catheterization, angioplasty, and even cardiac surgery. Once her condition stabilizes, other treatments include medications, lifestyle changes, and follow-up care.
What causes acute coronary syndrome?
The most common cause of acute coronary syndrome is coronary artery disease, or narrowing of the coronary arteries. These are the vessels that supply blood to the heart muscle. This narrowing is usually caused by plaque buildup on the artery walls, which leads to atherosclerosis, or hardening of the arteries.
In some cases, acute coronary syndrome can occur when the plaque in the artery suddenly opens. A blood clot forms over the cracked plaque, forming a narrowing inside the artery that partially or completely blocks blood flow. The sudden decrease in blood flow to the heart muscle cells causes the muscle cells to die.
There are several conditions that fall under the umbrella of acute coronary syndrome.
This occurs when the plaque in the artery suddenly opens. A blood clot forms over the cracked plaque and creates a sudden narrowing inside the artery. When this happens, chest pain or angina may occur more often and with less exercise, or may last longer than usual. This change in angina pattern is called unstable angina and causes an increased risk of heart attack.
If the heart is starving for blood and not getting enough oxygen for more than 20 minutes, part of the heart muscle will die, causing permanent damage. A heart attack (also called a myocardial infarction) is confirmed by blood tests, as well as a test that shows the electrical activity of the heart called an electrocardiogram (ECG).
Some heart attacks involve only a small area of the heart and can be managed with standard medical treatment in hospital. However, if the coronary artery in question is completely blocked by clots, the blood flow is completely stopped and the heart muscle fed by this artery is damaged. This causes a characteristic change in the EKG called ST-segment elevation myocardial infarction (STEMI) and requires immediate treatment.
Who is at risk?
The risk factors for acute coronary syndrome are similar to those of other heart diseases. It generally includes:
- Covid-19 disease
- high blood pressure (hypertension)
- high cholesterol
- To smoke
- Not participating in physical activities
- eating unhealthy
- obesity or being overweight
- diabetes (diabetes)
- Having the same or similar ailments in the family
- History of high blood pressure, preeclampsia, or diabetes ( gestational diabetes ) during pregnancy
What are the symptoms of acute coronary syndrome?
Acute coronary syndrome can occur at rest or during exertion. Symptoms can include any of the following:
- Chest pain, often described as tightness or heaviness
- pain in the upper abdomen
- pain in the back, neck, jaw, or arm
- Shortness of breath
- Loss of consciousness
Unlike men, for some women, chest pain may not be the first sign of heart disease. These women report less common symptoms such as unusual tiredness, difficulty sleeping, indigestion and anxiety up to a month before their heart attack. Women with diabetes usually have fewer symptoms.
If you think you may be having a heart attack, call 112.
When should you see a doctor?
If you have other symptoms listed above and related, you should see your doctor immediately.
How is acute coronary syndrome diagnosed?
If there are symptoms associated with acute coronary syndrome, an emergency room doctor will likely order several tests. Some tests may be done while the doctor asks the patient about their symptoms and medical history. Tests include:
- Electrocardiogram (ECG): Electrodes attached to the skin measure the electrical activity in the heart. Abnormal or irregular stimuli may mean that the heart is not working properly due to a lack of oxygen to the heart. Certain patterns in electrical signals can indicate the general location of a blockage. The test can be repeated several times.
- Blood tests: If cell death has damaged heart tissue, certain enzymes can be detected in the blood. A positive result indicates a heart attack.
Information from these two tests is used to make the primary diagnosis of acute coronary syndrome. The doctor can use this information to determine whether the patient’s condition should be classified as a heart attack or unstable angina.
Other tests may be done to learn more about the condition, rule out other causes of symptoms, or detail diagnosis and treatment.
- Coronary angiography: This procedure uses X-ray imaging to see the blood vessels of the heart. A long, small tube (catheter) is passed from an artery in the arm or groin to the arteries in the heart. A dye flows through the tube into the arteries. A series of X-rays shows how the dye moves through the arteries and reveals any blockages or narrowings.
- Echocardiogram: An echocardiogram uses sound waves directed at the heart from a wand-like device to create a live image of the heart. An echocardiogram can help determine if the heart is pumping properly.
- Myocardial perfusion imaging: This test shows how well blood is flowing through the heart muscle. A very small, safe amount of radioactive material is injected into the blood. A special camera takes heart images of the matter’s path. They show the doctor whether enough blood is flowing through the heart muscles and where the blood flow is reduced.
- Computed tomography (CT) angiogram: Computed tomography angiogram uses special X-ray technology that can create multiple images of the heart. These images can detect narrowed or clogged coronary arteries.
- Stress test: Stress test reveals how well your heart works when exercised. In some cases, a medication may also be taken to increase the heart rate instead of exercising. This test is only done when there are no signs of acute coronary syndrome or another life-threatening heart condition.
How is acute coronary syndrome treated?
The immediate goals of treatment for acute coronary syndrome are:
- Relieve pain and distress
- improve blood flow
- Restoring heart function as quickly and optimally as possible
Long-term treatment goals are to improve overall heart function, manage risk factors, and reduce the risk of heart attack. A combination of medication and surgical procedures can be used to achieve these goals.
Depending on the diagnosis, medications for emergency or continuing care (or both) may include:
- Thrombolytics: Help dissolve a blood clot blocking an artery.
- Nitroglycerin: Improves blood flow by temporarily widening blood vessels.
- Antiplatelet drugs : Help prevent blood clots from forming.
- Beta blockers: They help relax the heart muscle and slow the heart rate. They reduce the demand on the heart and lower blood pressure.
- Angiotensin-converting enzyme (ACE) inhibitors: They dilate blood vessels and improve blood flow, making the heart work better.
- Angiotensin receptor blockers (ARBs): Help control blood pressure.
- Statins: They lower the amount of cholesterol moving through the blood and stabilize plaque deposits, making them less likely to break down.
Remember, your doctor will decide which medicine to take and how.
Surgery and other procedures
The doctor may recommend one of the following procedures to restore blood flow to the heart muscles:
- Angioplasty and stenting: In this procedure, the doctor inserts a long, small tube (catheter) into the blocked or narrowed portion of the artery. A wire with a deflated balloon is passed through the catheter into the narrowed area. The balloon is then inflated and the artery is opened, compressing the plaque deposits against the artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
- Coronary bypass surgery: With this procedure, a surgeon takes a piece of blood vessel (graft) from another part of the body and creates a new pathway for blood to circulate (skip) around a blocked coronary artery.