Acute Coronary Syndrome

Acute Coronary Syndrome (ACS) affects around 7 million people around the world every year and includes conditions such as acute myocardial infarction and unstable angina.

Here, we will take a closer look at the signs, symptoms, diagnosis and treatments available for this condition.

Understanding Acute Coronary Syndrome

Acute Coronary Syndrome (ACS) covers a range of conditions associated with a sudden reduction in blood flow to the heart muscle.

• Unstable Angina, which increases the risk of a heart attack
• ST-Elevation Myocardial Infarction (STEMI): The complete block of blood to the heart. This can be seen on an ECG
• Non-ST-Segment Elevation Myocardial Infarction (NSTEMI): This again is the blockage of blood to the heart, but is not complete and will not show on an ECG

Pathophysiology of Acute Coronary Syndrome

ACS is caused by atherosclerosis, where plaque forms blood clots within coronary arteries. This can reduce or block the flow of blood, nutrients and oxygen to the myocardium in the heart. While plaque build up over a very long time is known as stable ischemic heart disease and can lead to stable angina, ACS is sudden.

• Plaque rupture, where the plaque breaks open
• Thrombosis, where the artery is blocked
• Decreased blood flow, leading to myocardial ischemia or infarction

Risk Factors and Epidemiology

Acute Coronary Syndrome, like heart failure and stroke particularly impact those over the age of 35. Risk factors include:

• Smoking, lack of physical activity, poor diet, obesity
• High blood pressure, high blood cholesterol, and diabetes
• Gender (more common in males) and those with a family history of coronary heart disease

Symptoms of Acute Coronary Syndrome

• Chest pain or discomfort, particularly at rest. Symptoms may include pressure or tightness in the chest, or a burning sensation
• Pain that spreads from the chest to the back, neck, jaw, shoulders, and arms
• Nausea, vomiting, shortness of breath, excessive sweating, lightheadedness, dizziness, or fainting
• Hypotension, hypertension, and pulmonary edema

Diagnosis and Treatment Options

Diagnosis

• Electrocardiogram (ECG or EKG) to distinguish between the different types of ACS
• Blood tests to measure cardiac biomarkers like troponins, to detect damage to heart muscle
• Physical examinations and full medical historys
• CT scans or MRIs to evaluate the severity and location of blockages
• Stress testing, such as exercise or medication-induced to assess heart function
• Coronary Angiography, using a catheter to see the flow of blood to identify blockages

Treatment

• Medication includes aspirin, heparin, and antiplatelets (prasugrel) to prevent further clotting. Long-term treatment includes beta-blockers, angiotensin converting enzyme (ACE) inhibitors, ARBs, thrombolytics, and statins. Nitroglycerin may also be used to improve blood flow and relieve chest pain
• Angioplasty with stenting or coronary artery bypass grafting (CABG) may be used to restore blood flow
• Cardiac rehabilitation to improve heart function through lifestyle changes

Lifestyle Modifications to reduce ACS

• Quit Smoking and the prevention of exposure to secondhand smoke
• Dietary changes to include fruits, vegetables, whole grains, lean meats, and low-fat dairy products
• Regular physical activity, to include at least 30 minutes of exercise 5 days a week to maintain cardiovascular health
• Weight management through a balanced diet and regular exercise
• Stress management techniques

Medical Management and Monitoring

• Regular monitoring of blood pressure to help manage high blood pressure
• Checking cholesterol levels regularly
• Managing blood sugar levels within recommended ranges
• Dual Antiplatelet Therapy (DAPT) to reduce the risk of thrombosis

Proactive Health Practices

• Regular check-ups with a healthcare provider
• Education to recognize the signs of ACS and understand when to seek medical intervention
• Limiting alcohol intake
• Ensuring 7 to 9 hours of good quality sleep each night
• Working closely with healthcare professionals

Frequently Asked Questions about Acute Coronary Syndrome

How is Acute Coronary Syndrome (ACS) identified and diagnosed?

Acute Coronary Syndrome may be diagnosed using ECG’s, measuring for specific biomarkers, or through invasive coronary angiography, which involves injecting a dye into the coronary arteries to identify any blockages. Coronary angiography is normally used when coronary artery disease is highly likely.

What are the initial treatments recommended for acute coronary syndrome?

Initial treatment includes a 300 mg dose of aspirin and a heparin bolus followed by an intravenous heparin infusion. Anti-platelet therapy with either ticagrelor or clopidogrel is also recommended. Other treatments include anticoagulants, and beta-blockers. In cases of STEMI, the American Heart Association (AHA) recommends emergency treatments like fibrinolytic drugs, percutaneous coronary intervention (PCI), or coronary artery bypass graft surgery.

Sources

• Acute coronary syndrome – Mayo Clinic