Acute Coronary Syndrome – Causes, Risk factors, Symptoms, Diagnosis, Treatment, Prevention

(SCA, unstable angina pectoris)

What is Acute Coronary Syndrome

Acute coronary syndrome (ACS), also know as Unstable Angina Pectorisis, a term that describes symptoms related to poor blood flow to the heart muscle that leads to a heart attack. The result is chest pain or angina pectoris. This is a very serious disease that is life threatening. If you think you have ACS, seek medical attention immediately.

Acute Coronary Syndrome Causes

ACS is caused by a sudden blockage of the coronary arteries, which are the blood vessels that carry blood to the heart muscle. The blood flow to the heart muscle is drastically reduced or completely blocked. This causes the heart muscle to get damaged or die (heart attack).

Clots are usually the cause of narrowing of the arteries. Most often, narrowing occurs from years of plaque buildup in an artery. This accumulation is called atherosclerosis.

Acute Coronary Syndrome Risk factors

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

  • A family history of heart disease
  • Is a man over 45 years of age or a woman over 55 years of age
  • Being overweight or obese
  • Smoke
  • High cholesterol, especially, high LDL (“bad”) cholesterol, high triglycerides and low HDL (“good”) cholesterol.
  • Hypertension
  • Diabetes
  • Be sedentary
  • Having angina, a previous heart attack, or other types of coronary artery disease

Acute Coronary Syndrome Symptoms

The SCA is very serious and requires immediate medical attention. Contact your doctor if you experience any of the following symptoms:

  1. Angina: chest pain, pressure, hardness, burning or any discomfort that lasts a few minutes, disappear and then return. It usually occurs after a physical effort, emotional stress or after a hearty meal.
  2. Unstable angina: frequently occurs at rest, when sleeping or when doing very little effort. It can last 30 minutes or more.
  3. Pain or discomfort in one arm or both, shoulders, back, neck, jaw or stomach
  4. Shortness of breath that accompanies pain in the chest 
  5. Feeling numb or dizzy
  6. Feeling nausea and vomiting
  7. Sweating is usually present

Acute Coronary Syndrome Diagnosis

The doctor will ask about your symptoms and medical history. You will have a physical exam. If you suspect that you have SCA, call an ambulance. At the hospital, tests may include the following:

  • Electrocardiogram (ECG or EKG): measures the speed and regularity of the heart rhythm. It can show the damage caused to the heart.

Blood tests to measure different enzymes that are released when heart muscle cells die, including:

  • Troponin test: it is considered the most accurate, it can determine if a heart attack has occurred and how much additional damage the heart suffered.
  • CK or CK-MB test: measures creatine kinase (CK) in the blood.
  • Myoglobin test: controls the presence of myoglobin in the blood.
  • Nuclear heart scan: radioactive markers allow to highlight the cardiac chambers and the main blood vessels that go to and leave the heart.
  • Cardiac catheterization: can determine the pressure and blood flow in the cardiac chambers, collect blood samples from the heart and examine the arteries of the heart with x-rays.
  • Coronary angiography: produces images of the blood flow through the heart and allows to identify where the blockages are.
  • Echocardiogram: a study that uses sound waves to produce a moving image of the heart.
    Chest x-ray: images of the inside of the thorax to evaluate the size of the heart and show pulmonary congestion and the presence of pneumonia.

Acute Coronary Syndrome Treatment

If you have a heart attack, doctors will do the following:

  • They will work quickly to restore blood flow to the heart
  • They will closely monitor vital signs to detect and treat complications

To restore blood flow, the main treatments are:

  • All patients with possible acute coronary syndrome are given aspirin.
  • Anti-ischemic medications, such as nitroglycerin, are used to help relieve chest pain.
  • Beta-blockers are given to decrease the heart rate so that it does not consume too much energy.

Thrombolytic medications are used to dissolve blood clots. When given shortly after a heart attack began, these medications can limit or prevent permanent damage to the heart. To be more effective, they need to be administered within one hour after the symptoms of a heart attack began. Some thrombolytic medications are:

  • Streptomycin
  • TPA

Platelet inhibitors prevent the blockage from getting worse:

  • Eptifibatide
  • Tirofiban
  • Antagonist of glycoprotein IIb / IIIa receptors
  • Angioplasty: a catheter is inserted into a blocked artery. A balloon is inflated and deflated to allow the blood to flow again. A stent can be placed.
  • Coronary artery bypass surgery: arteries or veins are taken from other parts of the body. They are used to divert the blocked arteries of the heart.
  • All patients are given oxygen.

According to a 2008 review, the treatment of ACS with angiography and revascularization (restoration of blood flow to the heart) may reduce the likelihood of being re-admitted. However, surgery did not reduce the death rate or heart attack.

How to Prevent Acute Coronary Syndrome

To help reduce your chances of getting ACS, follow the same heart-healthy lifestyle suggestions that help prevent other types of coronary artery disease, for example:

  1. Eat a well-balanced diet. It must have a low content of saturated fats. The diet should also be rich in fruits, vegetables and whole grains.
  2. Exercise regularly
  3. If you smoke, stop doing it.
  4. Control diabetes, blood pressure and cholesterol. This can include changes in lifestyle and medications.

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