Acute coronary syndrome is a term used to describe a variety of conditions associated with a sudden decrease in blood flow to the heart.
One of those conditions is heart attack (myocardial infarction), when cell death results in damaged or destroyed heart tissue. Although severe coronary syndrome does not cause cell death, decreased blood flow changes the way your heart works and is a sign of an increased risk of heart attack.
Acute coronary syndrome often causes severe pain or discomfort in the chest. This is a medical emergency that requires immediate diagnosis and care. The goals of treatment are to improve blood flow, treat problems, and prevent future problems.
Acute coronary syndrome is the name given to three types of coronary artery disease associated with a sudden rupture of plaque within the coronary artery:
Unstable angina
Myocardial infarction or non-EST segment elevation myocardial infarction (STEMI)
ST-segment elevation Myocardial infarction or heart attack (STEMI).
The location of the blockage, how long blood flow is blocked, and the amount of damage that occurs determine the type of acute coronary syndrome. These life-threatening conditions require emergency medical attention.
Unstable angina is a new symptom or change from stable angina. Angina occurs more often, occurs more easily at rest, feels more severe, or lasts longer. Although this angina can often be relieved with oral medication, it is unstable and can lead to a heart attack. It usually requires a more serious medical procedure or treatment. Unstable angina is a severe coronary syndrome and should be considered a medical emergency.
Heart attack: non-EST segment elevation myocardial infarction (NSTEMI)
This heart attack, or MI, may not cause changes on the electrocardiogram (ECG). However, chemical markers in the blood indicate damage to the heart muscle. In NSTEMI, the blockage can be partial or temporary, so the extent of damage is very small.
Heart attack: ST-segment elevation myocardial infarction (STEMI)
This heart attack, or MI, is caused by a sudden and chronic blocked blood supply. It affects a large area of the heart muscle, causing changes in the blood levels of key chemical markers along with the ECG.
Other words for heart attack:
Shocked myocardium
If blood flow returns to the heart muscle area after ischemia (lack of blood supply), the heart muscle may not pump normally for a time. This is called a "stunned" heart muscle or myocardium.
Myocardial infarction
If the blood supply is not adequate for a long time, certain areas of the heart muscle will stop working. There will be permanent damage in some areas. If blood flow to that area is restored (either through medication or a procedure), other areas can return to normal function. The inactive myocardium is the heart muscle that can "rest" or "sleep" and return to normal function if properly treated.
Symptoms
The signs and symptoms of acute coronary syndrome usually begin abruptly. Among them are:
Chest pain (angina) or discomfort, often described as pain, pressure, tightness, or burning
The pain spreads from the chest to the shoulders, arms, abdomen, back, neck, or jaw.
Nausea or vomiting
Indigestion
Respiratory dyspnea
Sudden, severe sweating (diaphoresis)
Mild headache, dizziness, or fainting.
Unusual or unexplained fatigue
Feeling restless or scared
Pain or discomfort in the chest is a very common symptom. However, the signs and symptoms can vary significantly based on your age, gender, and other medical conditions. If you are female, elderly, or diabetic, you are more likely to have signs and symptoms without chest pain or discomfort.
Causes
Acute coronary syndrome is usually caused by the formation of fatty deposits (plaques) on the walls of the coronary arteries, where blood vessels carry oxygen and nutrients to the heart muscle.
When the plaque deposit breaks or divides, the blood clots. This clot blocks blood flow to the heart muscle.
When the oxygen supply to the cells is too low, the heart muscle cells die. Cell death - damage to muscle tissue - heart attack (myocardial infarction).
Even in the absence of cell death, oxygen depletion causes the heart muscle not to function as it should. This change can be temporary or permanent. When acute coronary syndrome does not lead to cell death, it is called transient angina.
Risk factors
The risk factors for acute coronary syndrome are similar to those for other types of heart disease. Risk factors for acute coronary syndrome:
Aging
Hypertension
High blood cholesterol
Smoking cigarettes
Lack of physical activity
Unhealthy diet
Ob late or overweight
Diabetes
Family history of chest pain, heart disease, or stroke.
History of high blood pressure, preeclampsia, or diabetes during pregnancy
Covid-19 infection
Diagnosis
If you have signs or symptoms associated with severe coronary syndrome, Cardiologist may order various tests. Some tests may be done when your doctor asks about your symptoms or medical history. The tests include:
Electrocardiogram (ECG). Electrodes attached to your skin measure the electrical activity of your heart. Abnormal or irregular impulses mean that your heart is not working properly due to a lack of oxygen to the heart. Some models of electrical signs show the general location of the obstacle. The test can be repeated several times.
Blood test. Some enzymes are found in the blood if cell death damages heart tissue. A positive result indicates a heart attack.
The information from these two tests, as well as their signs and symptoms, can be used to make an initial diagnosis of acute coronary syndrome. Your doctor can use the information to find out if your condition can be classified as a heart attack or transient angina.
Other tests may be done to learn more about your condition, to rule out other causes of symptoms, or to help your doctor personalize your diagnosis and treatment.
Coronary angiogram This procedure uses x-ray images to view the blood vessels in your heart. A long and short tube (catheter) is inserted through an artery, usually in the arm or groin, through the arteries of the heart. A dye flows through a tube into the arteries. The x-ray matrix shows how the color moves through the arteries, any blockage or narrowing. It can also be used for catheter treatments.
Echocardiogram. The echocardiogram uses sound waves directed from a wand-like device toward your heart to create a live image of your heart. An echocardiogram can help determine if the heart is pumping properly.
Images of myocardial perfusion. This test shows how well the blood is flowing through the heart muscle. A safe small amount of radioactive substance enters the bloodstream. A special camera takes pictures of matter's path through your heart. They will show your doctor if there is enough blood flowing through the heart muscle and where the blood flow is reduced.
Computed tomography (CT) angiography. CT angiography uses specialized X-ray technology that can produce multiple images of your heart - 2-D cross-sectional fragments. These images can identify narrow or blocked coronary arteries.
Stress test. Stress tests reveal how well your heart is working when you exercise. In some cases, you can get an action potion to increase your heart rate without exercising. This test is done only when you are at rest and there are no signs of severe coronary syndrome or another malignant heart condition. During a stress test, an ECG, echocardiogram, or myocardial perfusion imaging may be used to see how well your heart is working.
Treatment
Immediate goals of acute coronary syndrome treatment:
Relief from pain and suffering.
Improve blood flow
Restore heart function as quickly and optimally as possible
The long-term goals of treatment are to improve overall heart function, control risk factors, and reduce the risk of heart attack. A combination of medications and surgical procedures can be used to achieve these goals.
Medications
Depending on your diagnosis, medications for continuing or emergency care (or both) may include the following:
Thrombolytics (clot busters) dissolve blood clots that are blocking the artery.
Nitroglycerin improves blood flow by temporarily dilating blood vessels.
Antiplatelet medications help prevent blood clots and include aspirin, clopidogrel (Plavix), Prasugrel (Efficient), and others.
Beta-blockers can help relax your heart muscle and slow your heart rate. They reduce the demand on your heart and lower your blood pressure. Some examples are metoprolol (Lopressor, Toprol-XL) and Nadolol (Cargard).
Angiotensin converting enzyme (ACE) inhibitors dilate blood vessels and improve blood flow, allowing the heart to function better. These include lisinopril (prinivil, gestril), benazepril (batch sin), and others.
Angiotensin receptor blockers (ARBs) help control blood pressure and include Irbesartan (Avapro), Losartan (Kozar), and many others.
Statins reduce the amount of cholesterol that moves in the blood and can stabilize plaque deposits, making them less likely to break down. Statins include atorvastatin (Lipitor), simvastatin (Zocor, flo lipid), and many others.
Surgery and other procedures
Your doctor may recommend one of these procedures to restore blood flow to the heart muscle:
Angioplasty and stenting. During this procedure, your doctor inserts a long, short tube (catheter) into the blocked or narrow part of your artery. A lead with an abandoned balloon passes through a catheter into a narrow area. The balloon is then inflated and opens the artery, compressing the plaque deposits against the arterial walls. The mesh tube (stent) is usually left in the artery to keep the artery open.
Coronary bypass surgery. With this procedure, a surgeon takes a piece of blood vessel (graft) from another part of your body and creates a new path for blood to pass (bypass) the blocked coronary artery.
Lifestyle and home remedies
Heart-healthy lifestyle changes are an important part of preventing heart attacks. Recommendations include:
Do not smoke. If you smoke, stop it. Talk to your doctor if you need help getting out. Also, avoid secondhand smoke.
Eat a heart-healthy diet. Eat lots of fruits and vegetables, whole grains and low-fat dairy and lean meats.
Be active. Exercise regularly and be physically active. If you don't exercise regularly, talk to your doctor about the best exercise to start a healthy and safe routine.
Control your cholesterol. Check your blood cholesterol levels regularly at your doctor's office. Avoid meats and dairy products that are high in fat and cholesterol. If your doctor prescribes statins or other cholesterol-lowering medications, take them daily as prescribed by your doctor.
Check your blood pressure. Check your blood pressure regularly as recommended by your doctor. Take your blood pressure medicine every day as recommended.
Keep a healthy weight. Being overweight can damage your heart and contribute to high cholesterol, high blood pressure, diabetes, heart disease, and other conditions.
Manage stress. To reduce your risk of heart attack, reduce stress in your daily activities. Rethink work habits and find healthy ways to reduce or resolve stressful events in your life. Talk to your doctor or mental health professional if you need help managing stress.
Drink alcohol in moderation. If you drink alcohol, do so in moderation. Drinking more than one or two alcoholic drinks a day can raise your blood pressure.
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