Acute Coronary Syndrome (ACS) is a term given to various heart conditions including a Heart Attack (Myocardial Infarction) and Unstable Angina. These conditions are due to there being a reduced amount of blood flowing to a part of the heart. Various treatments are given and these usually depend on the type of ACS. Treatments help to ease the pain, improve the blood flow and to prevent any future complications.
Myocardial Infarction : If you have a myocardial infarction, a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart muscle supplied by this artery loses its blood (and oxygen) supply. This part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word infarction means death of some tissue due to a blocked artery which stops blood from getting past.) In addition to being known as a heart attack, a myocardial infarction is sometimes called a coronary thrombosis.
Unstable angina : Unstable angina occurs when the blood clot causes a reduced blood flow, but not a total blockage. This means that the heart muscle supplied by the affected artery does not die (infarct).
Causes
Acute coronary syndrome is most often a complication of plaque buildup in the arteries in your heart (coronary atherosclerosis) These plaques, made up of fatty deposits, cause the arteries to narrow and make it more difficult for blood to flow through them.
Eventually, this buildup means that your heart can't pump enough oxygen-rich blood to the rest of your body, causing chest pain (angina) or a heart attack. Most cases of acute coronary syndrome occur when the surface of the plaque buildup in your heart arteries ruptures and causes a blood clot to form. The combination of the plaque buildup and the blood clot dramatically limits the amount of blood flowing to your heart muscle. If the blood flow is severely limited, a heart attack will occur.
Various other uncommon conditions can also block a coronary artery. For example :
- Inflammation of the coronary arteries (rare).
- A stab wound to the heart.
- A blood clot forming elsewhere in the body (for example, in a heart chamber) and travelling to a coronary artery where it gets stuck.
- Taking cocaine, which can cause a coronary artery to go into spasm.
- Complications from heart surgery.
Sign & Symptoms
1. The most common symptom of a ACS is having severe Chest Pain. The pain often feels like a heavy pressure on your chest. The pain may also travel up into your jaw and down your left arm, or down both arms.
2. Nausea / Vomiting
3. Shortness of Breath (dyspnea)
4. Sudden, heavy sweating (diaphoresis)
5. Feel sick and feel faint
6. Abdominal Pain
7. Pain similar to heartburn
8. Clammy skin
9. Lightheadedness
10. Dizziness or fainting
Tests and Diagnosis
1. Electrocardiogram (ECG)
This is the first test done to diagnose a heart attack. It's often done while you're being asked questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
2. Blood Tests
Certain heart enzymes slowly leak into your blood if your heart has been damaged by a heart attack. Emergency room staff will take samples of your blood to test for the presence of these enzymes.
3. Echocardiogram
If your doctor decides you haven't had a heart attack and your risk of having a heart attack is low, you'll likely have an echocardiogram before you leave the hospital. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally.
4. Chest X-ray
An X-ray image of your chest allows your doctor to check the size and shape of your heart and its blood vessels.
5. Nuclear scan
This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it is taken up by your heart muscle. Areas of reduced blood flow to the heart muscle — through which less of the radioactive material flows — appear as dark spots on the scan. Nuclear scans are occasionally done while you're having chest pain to check the blood flow to your heart muscle, but more often, are done as part of a stress test.
6. Computerized tomography (CT) angiogram
A CT angiogram allows your doctor to check your arteries to see if they're narrowed or blocked. In this minimally invasive test, you'll change into a hospital gown and lie on a table that's part of the CT scanning machine. You'll receive an injection of a radioactive dye, and the doughnut-shaped CT scanner will be moved to take images of the arteries in your heart. The images are then sent to a computer screen for your doctor to view. This test is usually only done if your blood tests and electrocardiogram don't reveal the cause of your symptoms.
7. Coronary angiogram (cardiac catheterization)
This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage. Additionally, while the catheter is in position, your doctor may treat the blockage by performing an angioplasty. Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. Often, a mesh tube (stent) also is placed inside the artery to hold it open more widely and prevent re-narrowing in the future.
Treatment
Treatment for acute coronary syndrome varies, depending on your symptoms and how blocked your arteries are.
1. Medications
It's likely that your doctor will recommend medications that can relieve chest pain and improve flow through the heart. These could include :
✔ Aspirin
Aspirin decreases blood clotting, helping to keep blood flowing through narrowed heart arteries. Aspirin is one of the first things you may be given in the emergency room for suspected acute coronary syndrome. You may be asked to chew the aspirin so that it's absorbed into your bloodstream more quickly. If your doctor diagnoses your symptoms as acute coronary syndrome, he or she may recommend taking an 81-milligram dose of aspirin daily.
✔ Thrombolytics
These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. If you're having a heart attack, the earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart. However, if you are close to a hospital with a cardiac catheterization laboratory, you'll usually be treated with emergency angioplasty and stenting instead of thrombolytics. Clotbuster medications are generally used when it will take too long to get to a cardiac catheterization laboratory, such as in rural communities.
✔ Nitroglycerin
This medication for treating chest pain and angina temporarily widens narrowed blood vessels, improving blood flow to and from your heart.
✔ Beta blockers
These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure, which decreases the demand on your heart. These medications can increase blood flow through your heart, decreasing chest pain and the potential for damage to your heart during a heart attack.
✔ Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
✔ Calcium channel blockers
These medications relax the heart and allow more blood to flow to and from the heart. Calcium channel blockers are generally given if symptoms persist after you've taken nitroglycerin and beta blockers.
✔ Cholesterol-lowering drugs
Commonly used drugs known as statins can lower your cholesterol levels, making plaque deposits less likely, and they can stabilize plaque, making it less likely to rupture.
✔ Clot-preventing drugs
Medications such as clopidogrel (Plavix) and prasugrel (Effient) can help prevent blood clots from forming by making your blood platelets less likely to stick together. However, clopidogrel increases your risk of bleeding, so be sure to let everyone on your health care team know that you're taking it, particularly if you need any type of surgery.
2. Surgery and other Procedures
If medications aren't enough to restore blood flow through your heart, your doctor may recommend one of these procedures:
✄ Angioplasty and Stenting
In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
✄ Coronary Bypass Surgery
This procedure creates an alternative route for blood to go around a blocked coronary artery.
Reference :
1. Mayo Clinic : http://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/basics/treatment/con-20033942
2. Patient.co.uk : http://www.patient.co.uk/health/acute-coronary-syndrome-leaflet
Related Article :
- Myocardial Infarction (Heart Attack)
- Unstable Angina Pectoris
- Myocarditis (Inflammatory Cardiomyopathy)
- Medical Causes of Chest Pain
Myocardial Infarction : If you have a myocardial infarction, a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart muscle supplied by this artery loses its blood (and oxygen) supply. This part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word infarction means death of some tissue due to a blocked artery which stops blood from getting past.) In addition to being known as a heart attack, a myocardial infarction is sometimes called a coronary thrombosis.
Unstable angina : Unstable angina occurs when the blood clot causes a reduced blood flow, but not a total blockage. This means that the heart muscle supplied by the affected artery does not die (infarct).
Causes
Acute coronary syndrome is most often a complication of plaque buildup in the arteries in your heart (coronary atherosclerosis) These plaques, made up of fatty deposits, cause the arteries to narrow and make it more difficult for blood to flow through them.
Eventually, this buildup means that your heart can't pump enough oxygen-rich blood to the rest of your body, causing chest pain (angina) or a heart attack. Most cases of acute coronary syndrome occur when the surface of the plaque buildup in your heart arteries ruptures and causes a blood clot to form. The combination of the plaque buildup and the blood clot dramatically limits the amount of blood flowing to your heart muscle. If the blood flow is severely limited, a heart attack will occur.
Various other uncommon conditions can also block a coronary artery. For example :
- Inflammation of the coronary arteries (rare).
- A stab wound to the heart.
- A blood clot forming elsewhere in the body (for example, in a heart chamber) and travelling to a coronary artery where it gets stuck.
- Taking cocaine, which can cause a coronary artery to go into spasm.
- Complications from heart surgery.
Related Article :
Sign & Symptoms
1. The most common symptom of a ACS is having severe Chest Pain. The pain often feels like a heavy pressure on your chest. The pain may also travel up into your jaw and down your left arm, or down both arms.
2. Nausea / Vomiting
3. Shortness of Breath (dyspnea)
4. Sudden, heavy sweating (diaphoresis)
5. Feel sick and feel faint
6. Abdominal Pain
7. Pain similar to heartburn
8. Clammy skin
9. Lightheadedness
10. Dizziness or fainting
Tests and Diagnosis
1. Electrocardiogram (ECG)
This is the first test done to diagnose a heart attack. It's often done while you're being asked questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
2. Blood Tests
Certain heart enzymes slowly leak into your blood if your heart has been damaged by a heart attack. Emergency room staff will take samples of your blood to test for the presence of these enzymes.
3. Echocardiogram
If your doctor decides you haven't had a heart attack and your risk of having a heart attack is low, you'll likely have an echocardiogram before you leave the hospital. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally.
4. Chest X-ray
An X-ray image of your chest allows your doctor to check the size and shape of your heart and its blood vessels.
5. Nuclear scan
This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it is taken up by your heart muscle. Areas of reduced blood flow to the heart muscle — through which less of the radioactive material flows — appear as dark spots on the scan. Nuclear scans are occasionally done while you're having chest pain to check the blood flow to your heart muscle, but more often, are done as part of a stress test.
6. Computerized tomography (CT) angiogram
A CT angiogram allows your doctor to check your arteries to see if they're narrowed or blocked. In this minimally invasive test, you'll change into a hospital gown and lie on a table that's part of the CT scanning machine. You'll receive an injection of a radioactive dye, and the doughnut-shaped CT scanner will be moved to take images of the arteries in your heart. The images are then sent to a computer screen for your doctor to view. This test is usually only done if your blood tests and electrocardiogram don't reveal the cause of your symptoms.
7. Coronary angiogram (cardiac catheterization)
This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage. Additionally, while the catheter is in position, your doctor may treat the blockage by performing an angioplasty. Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. Often, a mesh tube (stent) also is placed inside the artery to hold it open more widely and prevent re-narrowing in the future.
Treatment
Treatment for acute coronary syndrome varies, depending on your symptoms and how blocked your arteries are.
1. Medications
It's likely that your doctor will recommend medications that can relieve chest pain and improve flow through the heart. These could include :
✔ Aspirin
Aspirin decreases blood clotting, helping to keep blood flowing through narrowed heart arteries. Aspirin is one of the first things you may be given in the emergency room for suspected acute coronary syndrome. You may be asked to chew the aspirin so that it's absorbed into your bloodstream more quickly. If your doctor diagnoses your symptoms as acute coronary syndrome, he or she may recommend taking an 81-milligram dose of aspirin daily.
✔ Thrombolytics
These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. If you're having a heart attack, the earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart. However, if you are close to a hospital with a cardiac catheterization laboratory, you'll usually be treated with emergency angioplasty and stenting instead of thrombolytics. Clotbuster medications are generally used when it will take too long to get to a cardiac catheterization laboratory, such as in rural communities.
✔ Nitroglycerin
This medication for treating chest pain and angina temporarily widens narrowed blood vessels, improving blood flow to and from your heart.
✔ Beta blockers
These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure, which decreases the demand on your heart. These medications can increase blood flow through your heart, decreasing chest pain and the potential for damage to your heart during a heart attack.
✔ Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
✔ Calcium channel blockers
These medications relax the heart and allow more blood to flow to and from the heart. Calcium channel blockers are generally given if symptoms persist after you've taken nitroglycerin and beta blockers.
✔ Cholesterol-lowering drugs
Commonly used drugs known as statins can lower your cholesterol levels, making plaque deposits less likely, and they can stabilize plaque, making it less likely to rupture.
✔ Clot-preventing drugs
Medications such as clopidogrel (Plavix) and prasugrel (Effient) can help prevent blood clots from forming by making your blood platelets less likely to stick together. However, clopidogrel increases your risk of bleeding, so be sure to let everyone on your health care team know that you're taking it, particularly if you need any type of surgery.
2. Surgery and other Procedures
If medications aren't enough to restore blood flow through your heart, your doctor may recommend one of these procedures:
✄ Angioplasty and Stenting
In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
✄ Coronary Bypass Surgery
This procedure creates an alternative route for blood to go around a blocked coronary artery.
Reference :
1. Mayo Clinic : http://www.mayoclinic.org/diseases-conditions/acute-coronary-syndrome/basics/treatment/con-20033942
2. Patient.co.uk : http://www.patient.co.uk/health/acute-coronary-syndrome-leaflet
Related Article :
- Myocardial Infarction (Heart Attack)
- Unstable Angina Pectoris
- Myocarditis (Inflammatory Cardiomyopathy)
- Medical Causes of Chest Pain
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