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 (myocardial infarction) — 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 heart attack.
Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. Improving blood flow, treating complications and preventing future problems are goals of treatment.
The risk factors for acute coronary syndrome are the same as those for other types of heart disease. Acute coronary syndrome risk factors include:
- High blood pressure
- High blood cholesterol
- Cigarette smoking
- Lack of physical activity
- Unhealthy diet
- Obesity or overweight
- Family history of chest pain, heart disease or stroke
- History of high blood pressure, preeclampsia or diabetes during pregnancy
Causes Of Acute Coronary Syndrome
Acute coronary syndrome usually results from the buildup 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. This clot blocks the flow of blood to heart muscles.
When the supply of oxygen to cells is too low, cells of the heart muscles can die. The death of cells — resulting in damage to muscle tissues is a heart attack (myocardial infarction).
Even when there is no cell death, the decrease in oxygen still results in heart muscles that don’t work the way they should. This change may be temporary or permanent. When acute coronary syndrome doesn’t result in cell death, it is called unstable angina.
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 aching, pressure, tightness or burning
- Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
- Nausea or vomiting
- Shortness of breath (dyspnea)
- Sudden, heavy sweating (diaphoresis)
- Lightheadedness, dizziness or fainting
- Unusual or unexplained fatigue
- Feeling restless or apprehensive
- Coronary angiogram. This procedure uses X-ray imaging to see your heart’s blood vessels. A long, tiny tube (catheter) is threaded through an artery, usually in your arm or groin, to the arteries in your heart. A dye flows through the tube into your arteries. A series of X-rays show how the dye moves through your arteries, revealing any blockages or narrowing. The catheter may also be used for treatments.
- Echocardiogram. An echocardiogram uses sound waves, directed at your heart from a wand-like device, to produce a live image of your heart. An echocardiogram can help determine whether the heart is pumping correctly.
- Myocardial perfusion imaging. This test shows how well blood flows through your heart muscle. A tiny, safe amount of radioactive substance is injected into your blood. A specialized camera takes images of the substance’s path through your heart. They show your doctor whether enough blood is flowing through heart muscles and where blood flow is reduced.
- Computerized tomography (CT) angiogram. A CT angiogram uses a specialized X-ray technology that can produce multiple images — cross-sectional 2-D slices — of your heart. These images can detect narrowed or blocked coronary arteries.
- Stress test. A stress test reveals how well your heart works when you exercise. In some cases, you may receive a medication to increase your heart rate rather than exercising. This test is done only when there are no signs of acute coronary syndrome or another life-threatening heart condition when you are at rest. During the stress test, an ECG, echocardiogram or myocardial perfusion imaging may be used to see how well your heart works.
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. Examples include metoprolol (Lopressor, Toprol-XL) and nadolol (Corgard).
- 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.
- Statins lower the amount of cholesterol moving in the blood and may stabilize plaque deposits, making them less likely to rupture. Statins include atorvastatin (Lipitor), simvastatin (Zocor, Flolipid) and several others.