Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a term that describes symptoms related to poor blood flow to the heart muscle leading to a heart attack. This results in chest pain, or angina pectoris. This is a very serious condition. ACS is a life-threatening condition. If you think you have ACS seek immediate medical treatment.

ACS is caused by a sudden blockage of the coronary arteries. These blood vessels carry blood to the heart muscle. The blood flow to the heart muscle is either greatly reduced or completely blocked. This leads to heart muscle damage or death (heart attack).

Blood clots are often the cause of the narrowing arteries. The narrowing most often happens from years of plaque build-up in an artery. This is called atherosclerosis .

The following factors increase your chances of developing acute coronary syndrome:

• Being overweight or obese
• A family history of heart disease
• Being sedentary
• Diabetes
• Having angina, a previous heart attack, or other types of coronary artery disease
• High blood pressure
• High cholesterol , especially high LDL ("bad") cholesterol, high triglycerides, and low HDL (“good”) cholesterol
• Smoking
• You are a man over 45 years old or a woman over 55 years old

ACS is very serious. It requires immediate medical treatment. Contact your doctor if you experience any of these symptoms:

• Angina—chest pain, pressure, tightness, burning, or other discomfort that may last a few minutes, go away, and then come back; often occurs after physical exertion, emotional stress or eating a large meal
• Feeling light-headed or dizzy
• Nausea and vomiting may occur
• Pain or discomfort in one or both arms, shoulders, the back, the neck, jaw, or stomach
• Shortness of breath that accompanies chest pain or may occur just before it
• Sweating often occurs
• Unstable angina—often occurs at rest, while sleeping, or with very little exertion; can last 30 minutes or longer.

Your doctor will ask about your symptoms and medical history. A physical exam will be done. If you suspect ACS, call an ambulance. At the hospital, tests may include the following:

• Blood tests to measure different enzymes that are released when cells in the heart muscle dies including:
  • CK or CK-MB test—measures creatine kinase (CK) in the blood
  • Myoglobin test—checks for the presence of myoglobin in the blood
  • Troponin test—considered the most accurate test; can determine if a heart attack has occurred and how much new damage was done to the heart
• Cardiac catheterization —can determine pressure and blood flow in the heart's chambers, collect blood samples from the heart, and examine the arteries of the heart by x-ray
• Chest x-ray —images of the inside of the chest to assess heart size and show lung congestion and the presence of pneumonia
• Coronary angiography —produces images of blood flow through the heart; will show where there are blockages are
• Echocardiogram —a test that uses sound waves to create a moving picture of your heart
• Electrocardiogram (ECG or EKG)—measures the rate and regularity of your heartbeat; can show damage done to the heart muscle
• Nuclear heart scan—radioactive tracers outline heart chambers and major blood vessels leading to and from the heart

If you are having a heart attack, doctors will: To restore blood flow, the main treatments are:

• Closely monitor vital signs to detect and treat complications
• Work quickly to restore blood flow to the heart

• Anti-ischemic drugs, such as nitroglycerin , are used to help relieve chest pain.
• Thrombolytic drugs are used to dissolve blood clots. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, they need to be given within one hour after the start of heart attack symptoms. Some thrombolytic drugs are:
  • Streptomycin
  • TPA
• Angioplasty—a catheter is inserted into a blocked artery. A balloon is inflated and deflated. This will allow blood to flow again. A stent may be placed.
• Aspirin is given to all patients suspected of acute coronary syndrome.
• Beta blockers are given to slow the heart rate so it does not use too much energy.
• Coronary artery bypass surgery—arteries or veins are taken from other areas in your body. They are used to bypass the blocked arteries in your heart.
• Oxygen is given to all patients.
• Platelet inhibitors keep the blockage from getting worse:
  • Eptifibatide
  • Glycoprotein IIb/IIIa receptor antagonist
  • Tirofiban

Based on a 2008 review, treating ACS with angiography and revascularization (restoring blood flow to the heart) may reduce the rate of being hospitalized again. But the surgery did not reduce the rate of death or heart attack.

To help reduce your chances of getting ACS, take the same heart-healthy lifestyle steps to prevent other forms of coronary artery disease such as:

• If you smoke, quit .
• Eating a well-balanced diet. It should be that is low in saturated fats. The diet should also be rich in fruits, vegetables, and whole grains.
• Exercising regularly.
• Manage you diabetes, blood pressure, and cholesterol. This can include lifestyle changes and medication.