Acute coronary syndrome : Causes-Symptoms-Diagnosis-Treatment

 What is Acute coronary syndrome?

for heart attack In the United States each year about 735,000 people have a sudden cardiac arrest (SCA) and only 9 percent survive About 450,000 of these SCAs are due to one of the four major coronary artery diseases so called acute coronary syndrome (ACS) Immediate treatment for STEMI heart attack patients (ST-segment elevation myocardial infarction) with an early invasive strategy is recommended based on several trials suggesting a survival benefit for invasive vs conservative strategies On the other hand if patient have Non ST-elevation myocardial infarction or unstable angina then they.

Medical terms

Acute coronary syndrome (ACS) is a term used to describe a spectrum of heart conditions that result from a sudden reduction or blockage of blood flow to the heart muscle. ACS is a medical emergency and typically includes three main conditions:

  • Unstable Angina: This is the mildest form of ACS. It occurs when there is a temporary reduction in blood flow to the heart muscle due to a partial blockage of one or more coronary arteries. Unstable angina can cause chest pain or discomfort, but it does not usually result in permanent damage to the heart muscle.

  • Non-ST Segment Elevation Myocardial Infarction (NSTEMI): NSTEMI is a more serious condition than unstable angina. It occurs when there is a partial blockage of a coronary artery that results in damage to the heart muscle. This damage can be detected by blood tests that measure cardiac biomarkers. People with NSTEMI typically experience chest pain or discomfort, and there is a risk of complications.

  • ST Segment Elevation Myocardial Infarction (STEMI): STEMI is the most severe form of ACS. It occurs when there is a complete blockage of a coronary artery, leading to a significant portion of the heart muscle being deprived of oxygen and nutrients. This can result in a large and often irreversible heart attack. STEMI is characterized by changes on an electrocardiogram (ECG) that show ST-segment elevation, and it requires immediate intervention to restore blood flow to the affected artery, often through procedures like angioplasty and stent placement.

The most common cause of ACS is the rupture of atherosclerotic plaques (cholesterol-rich deposits) in the coronary arteries. When a plaque ruptures, it can trigger the formation of a blood clot, which can partially or completely block blood flow in the affected artery, leading to ACS.

Disease Definition Question and Answer American Hospitals Alternative Medicine

Symptoms Acute coronary syndrome

The signs and symptoms of acute coronary syndrome usually begin abruptly. They include:

  • Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning

  • Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw

  • Nausea or vomiting

  • Indigestion

  • Shortness of breath (dyspnea)

  • Sudden, heavy sweating (diaphoresis)

  • Lightheadedness, dizziness or fainting

  • Unusual or unexplained fatigue

  • Feeling restless or apprehensive

Chest pain or discomfort is the most common symptom. However, signs and symptoms may vary significantly depending on your age, sex and other medical conditions. You're more likely to have signs and symptoms without chest pain or discomfort if you're a woman, older adult or have diabetes.

These symptoms ought to be taken seriously. If you experience pain or alternative symptoms, call 911 at once. “People square measure in denial and they’re sitting there thinking, ‘This can’t extremely be happening to Pine Tree State,’” Bolger aforesaid. “We wish them to feel entitled to 911. They’re not being communicators.

Chest pain caused by acute coronary syndromes will return on suddenly, as is the case with a heart failure. alternative times, the pain is often unpredictable or deteriorates even with rest, each hallmark symptoms of unstable angina. People that experience chronic pain ensuing from years of steroid alcohol buildup in their arteries will develop associate degree acute coronary syndrome if a blood forms on high of the plaque buildup.

When to see a doctor

Acute coronary syndrome could be a medical emergency. Pain or discomfort are often a signal of any range of grievous conditions. Get emergency facilitation for prompt identification and acceptable care. don't drive yourself to the hospital.

Causes Acute coronary syndrome

  • Acute coronary syndrome sometimes results from the buildup of fatty deposits (plaques) in and on the walls of coronary arteries, the blood vessels delivering elements and nutrients to heart muscles.
  • When a plaque deposit ruptures or splits, a grume forms. This clot blocks the flow of blood to heart muscles.
  • When the availability of elements to cells is just too low, cells of the guts muscles will die. The death of cells — leading to injury to muscle tissues — could be a coronary failure (myocardial infarction).
  • Even once there's no death, the decrease in element still ends up in heart muscles that do not work the approach they must. This modification could also be temporary or permanent. Once acute coronary syndrome does not lead to death, it's known as unstable angina.

Risk factors Acute coronary syndrome

The risk factors for acute coronary syndrome are the same as those for other types of heart disease. Acute coronary syndrome risk factors include:

Your medical care doctor will assist you perceive your personal risk and what you'll be able to do concerning it. “[The physician] ought to even be the one to mention, ‘By the approach, if you ever have any of those symptoms, I would like you to call 911,’” Bolger mentioned. “If somebody has told you that before, you’re way more likely to try to do it.

Diagnosis Acute coronary syndrome

If you have signs or symptoms related to acute coronary syndrome, an Associate in Nursing ER doctor can seemingly order many tests. Some tests are also done whereas your doctor is asking you questions about your symptoms or medical record. Tests include:

  • Electrocardiogram (ECG). Electrodes attached to your skin measure the electrical activity in your heart. Abnormal or irregular impulses can mean your heart is not working properly due to a lack of oxygen. Certain patterns in electrical signals may show the general location of a blockage. The test may be repeated several times.

  • Blood tests. Certain enzymes could also be detected within the blood if necrobiosis has resulted in harm to heart tissue. A positive result indicates a coronary failure.
    The information from these 2 tests — furthermore as your signs and symptoms — is employed to create a primary diagnosing of acute coronary syndrome. Your doctor will use the data to see whether or not your condition is often classified as a coronary failure or unstable angina. 

Other tests may be done to learn more about your condition, rule out other causes of symptoms, or to help your doctor personalize your diagnosis and treatment.

  • Coronary angiogram. This procedure uses X-ray imaging to check your heart's blood vessels. A long, little tube (catheter) is rib through the Associate in Nursing artery, typically in your arm or groin, to the arteries in your heart. A dye flows through the tube into your arteries. A series of X-rays show however the dye moves through your arteries, revealing any blockages or narrowing. The tubing may additionally be used for treatments. 

  • Echocardiogram. An echocardiogram uses sound waves, directed at your heart from a wand-like device, to produce a live image of your heart. An echocardiogram can help determine whether the heart is pumping correctly.

  • Myocardial perfusion imaging. This take a look at shows however well blood flows through your cardiac muscle. A tiny, safe quantity of hot substance is injected into your blood. A specialized camera takes pictures of the substance's path through your heart. They show your doctor whether or not enough blood is flowing through heart muscles and wherever blood flow is reduced. 

  • Computerized tomography (CT) angiogram. A CT angiogram uses a specialized X-ray technology that can produce multiple images — cross-sectional 2-D slices — of your heart. These images can detect narrowed or blocked coronary arteries.

  • Stress test. An assay reveals however well your heart works after you exercise. In some cases, you'll receive drugs to extend your pulse rate instead of physical exercise. This take a look at is finished only if there aren't any signs of acute coronary syndrome or another serious heart disease after you are at rest. throughout the strain take a look at, an ECG, sonography or cardiac muscle insertion imaging could also be accustomed see however well your heart works. 

Treatment Acute coronary syndrome

The immediate goals of treatment for acute coronary syndrome are:

  • Relieve pain and distress

  • Improve blood flow

  • Restore heart function as quickly and as best as possible

Long-term treatment goals are to enhance overall heart operation, manage risk factors and lower the chance of an attack. a mix of medicine and surgical procedures is also accustomed to meet these goals.


Depending on your diagnosis, medications for emergency or ongoing care (or both) may include the following:

  • Thrombolytics (clot busters) help dissolve a blood clot that's blocking an artery.

  • Nitroglycerin improves blood flow by temporarily widening blood vessels.

  • Antiplatelet drugs help prevent blood clots from forming and include aspirin, clopidogrel (Plavix), prasugrel (Effient) and others.

  • Beta blockers help relax your muscular tissue and slow your pulse rate. They decrease the demand on your heart and lower force per unit area. Examples embody beta-adrenergic blocking agents (Lopressor, Toprol-XL) and Corgard (Corgard). 

  • Angiotensin-converting enzyme (ACE) inhibitors widen blood vessels and improve blood flow, allowing the heart to work better. They include lisinopril (Prinivil, Zestril), benazepril (Lotensin) and others.

  • Angiotensin receptor blockers (ARBs) help control blood pressure and include irbesartan (Avapro), losartan (Cozaar) and several others.

  • Statins lower the number of steroid alcohol occupying the blood and will stabilize plaque deposits, creating them less doubtless to rupture. Statins embody statin drug (Lipitor), statin drug (Zocor, Flo Lipid) and several others. 

Surgery and other procedures

Your doctor may recommend one of these procedures to restore blood flow to your heart muscles:

  • Angioplasty and stenting. In this procedure, your doctor inserts an extended, small tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is tried and true the tubing to the narrowed space. The balloon is then inflated, gaping the artery by pressing the plaque deposits against your artery walls. A mesh tube (stent) is typically left within the artery to assist 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 route for blood that goes around (bypasses) a blocked coronary artery.

Lifestyle and home remedies

Heart healthy lifestyle changes are an important part of heart attack prevention. Recommendations include the following:

  • Don't smoke. If you smoke, quit. Talk to your doctor if you need help quitting. Also, avoid secondhand smoke.

  • Eat a heart-healthy diet. Eat a diet with lots of fruits and vegetables, whole grains, and moderate amounts of low-fat dairy and lean meats.

  • Be active. Get regular exercise and keep physically active. If you have not traveled frequently, seek advice from your doctor regarding the simplest exercise to start a healthy and safe routine. 

  • Check your cholesterol. Have your blood sterol levels checked often at your doctor's workplace. Avoid high-fat, high-cholesterol meat and dairy farms. If your doctor has prescribed a lipid-lowering medicine or different cholesterol-lowering medication, take it daily as directed by your doctor. 

  • Control your blood pressure. Have your blood pressure checked regularly as recommended by your doctor. Take blood pressure medicine daily as recommended.

  • Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure, diabetes, heart disease and other conditions.

  • Manage stress. To reduce your risk of heart failure, cut back stress in your regular activities. Rethink work habits and realize healthy ways to attenuate or manage disagreeable events in your life. visit your doctor or a psychological state care specialist if you wish to facilitate managing stress. 

  • Drink alcohol in moderation. If you drink alcohol, do so in moderation. Drinking more than one to two alcoholic drinks a day can raise blood pressure.

Preparing for your appointment

If you've got sharp hurting or alternative symptoms of acute coronary syndrome, get emergency care at once or call 911.

Your description of symptoms provides necessary data to assist the associate degree emergency medical team create an identification. Be ready to answer the subsequent queries.

  • When did signs or symptoms appear?

  • How long did they last?

  • What symptoms are you currently experiencing?

  • How would you describe the pain?

  • Where is the pain located?

  • How would you rate the severity of pain?

  • Does anything worsen or lessen the symptoms?

General summary

Symptoms of ACS typically include chest pain or discomfort, which can radiate to the arms, neck, jaw, or back. Other symptoms may include shortness of breath, nausea, lightheadedness, and cold sweats. Prompt medical attention is crucial for individuals experiencing ACS to minimize damage to the heart muscle and improve the chances of a positive outcome.

Treatment for ACS often includes medications to relieve chest pain, reduce clot formation, and manage risk factors like high blood pressure and cholesterol levels. In more severe cases, invasive procedures such as angioplasty and stent placement or coronary artery bypass surgery may be necessary to restore blood flow to the heart. Long-term management typically involves lifestyle changes, medications, and cardiac rehabilitation to reduce the risk of future events.

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