Acute coronary syndrome is a term used to refer to a wide range of health conditions related to sudden, reduced blood flow to the heart. The blockage can be abrupt and occur in one instant or it may come and settle over a period. If acute coronary syndrome does not cause any cell death, the reduced blood flow changes the way the heart works and it can be a sign of a high risk of a heart attack. This condition often leads to severe chest pain or discomfort. It needs immediate medical care and help. The main aim of treatment includes improving blood circulation, treating complications, and averting future problems.
Usually, the signs and symptoms of acute coronary syndrome begin suddenly, which include:
Chest pain or discomfort, often categorised by aching, pressure, tightness or burning
Pain exuding from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
Shortness of breath
Sudden, intense sweating
Unexplained fatigue or tiredness
Chest pain or discomfort is the most common symptom; however, signs may very remarkably depend upon a person’s age, sex and other comorbid medical problems. Some people may have signs and symptoms without chest pain or any discomfort - women, older adults, or diabetic patients.
Acute coronary syndrome usually results from the build-up of fatty deposits (plaques) in and on the walls of coronary arteries, the blood vessels delivering oxygen and nutrients to heart muscles.
When a plaque deposit ruptures or splits, a blood clot forms, and this clot hinders the flow of blood to the heart muscles. Also, when the supply of oxygen to the cells is too low, cells of the heart muscles die. The death of cells results in damage to muscle tissues that results in a heart attack (myocardial infarction).
Even when there is no cell death, the decrease in oxygen supply can still result in heart muscles damage. This change may be temporary or permanent. Furthermore, when acute coronary syndrome doesn't cause cell death, it is called unstable angina.
Generally, the risk factors for acute coronary syndrome are the same as those for other types of heart disease. Risk factors include
High blood cholesterol
Unhealthy eating habits
Obesity or overweight
History of chest pain, heart disease or stroke among the family
History of high blood pressure, preeclampsia, or diabetes during pregnancy
Some of the tests suggested by the doctor when the patient is admitted to the hospital include:
Electrocardiogram (ECG): The electrodes attached to the skin measure the electrical activity of the heart. Any abnormal or irregular impulses denote that the heart is not functioning well due to poor oxygen supply.
Blood Tests: Certain enzymes can be noticed in the blood if cell death occurs due to damage to heart tissue. A positive result indicates a heart attack.
These two tests are used to make an initial diagnosis of the acute coronary syndrome. Additional tests are conducted to rule out other causes of symptoms or help doctors tailor treatment plans such as Coronary angiogram, echocardiogram, myocardial perfusion imaging, CT angiogram and thallium stress test.
The main goals of treatment for acute coronary syndrome include:
To ease pain and discomfort
Improve blood flow
Reinstate heart function as rapidly as possible
Long-term treatments goals are aimed to enhance overall cardiac function, deal with risk factors and lower the risk of a heart attack. A combination of medications and surgical procedures may be employed to attain these goals.
Medications are prescribed to address the immediate medical emergency or ongoing care that may include:
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
Surgery and other procedures are also recommended by health care providers to restore blood flow to heart muscles.
Angioplasty: A long thin tube is inserted into the blocked part of an artery. A wire with a deflated balloon is passed via the catheter to the narrowed part. The balloon is then inflated, opening the artery by compressing plaque build-up against artery walls. A stent is placed in the artery to aid keep the narrowed artery open.
Coronary Bypass Surgery: In the procedure, the surgeon takes a piece of blood vessel graft from another part of the body and makes a new way for the blood that travels around a blocked coronary artery.