Overview of acute coronary syndrome
The acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart.
One such condition is a heart attack when cell death results in damaged or destroyed heart tissue. Even when acute coronary syndrome causes no cell death, the reduced blood flow changes how your heart works and is a sign of a high risk of a heart attack.
The acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment include improving blood flow, treating complications and preventing future problems.
What are the symptoms of acute coronary syndrome?
The signs and symptoms of acute coronary syndrome usually begin abruptly. They include:
- 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
- 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, signs and symptoms can vary significantly based on 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 of acute coronary syndrome
The 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 oxygen supply to the cells is too low, the heart muscle cells die.
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 for acute coronary syndrome
The risk factors for the acute coronary syndrome are similar to those for other types of heart disease. Risk factors for the acute coronary syndrome:
- High blood cholesterol
- Lack of physical activity
- Unhealthy diet
- Family history of chest pain, heart disease, or stroke.
- History of high blood pressure.
If you have signs or symptoms associated with the severe coronary syndrome, the emergency room doctor 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 the 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.
- 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 colour moves through the arteries, any blockage or narrowing. It can also be used for catheter treatments.
- 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 for acute coronary syndrome
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 a heart attack. A combination of medications and surgical procedures can be used to achieve 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 heart muscle and slow your heart rate. They decrease the demand on your heart and lower blood pressure.
- 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.
Lifestyle and home remedies
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.
- Check your cholesterol. Have your blood cholesterol levels checked regularly at your doctor’s clinic Avoid high-fat, high-cholesterol meat and dairy. If your doctor has prescribed a statin or other 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 a heart attack, reduce stress in your day-to-day activities. Rethink work habits and find healthy ways to minimize or deal with stressful events in your life. Talk to your doctor or mental health care professional if you need help managing stress.