Acute coronary syndrome

Acute Coronary Syndrome

Diagram illustrating a heart attack.

Scheme of acute coronary syndrome.

Acute Coronary Syndrome (ACS) is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. It encompasses conditions such as unstable angina and myocardial infarction (heart attack).

Pathophysiology

Acute coronary syndrome is primarily caused by the rupture of an atherosclerotic plaque in a coronary artery. This rupture leads to the formation of a thrombus (blood clot) that can partially or completely block the flow of blood to the heart muscle. The reduction in blood flow can cause ischemia, leading to damage or death of heart muscle cells.

Clinical Presentation

Patients with acute coronary syndrome may present with a variety of symptoms, including:

• Chest pain or discomfort, often described as a pressure or squeezing sensation.
• Pain radiating to the left arm, neck, jaw, or back.
• Shortness of breath.
• Nausea, vomiting, or diaphoresis (sweating).
• Fatigue or dizziness.

Diagnosis

The diagnosis of acute coronary syndrome is based on clinical evaluation, electrocardiogram (ECG) findings, and biomarkers such as troponin levels. An ECG may show ST-segment elevation, ST-segment depression, or T-wave inversion, depending on the type of ACS.

Management

Management of acute coronary syndrome involves both immediate and long-term strategies:

Immediate Management

• Oxygen therapy for patients with hypoxia.
• Aspirin to inhibit platelet aggregation.
• Nitroglycerin for chest pain relief.
• Anticoagulants such as heparin.
• Beta-blockers to reduce myocardial oxygen demand.
• Reperfusion therapy such as percutaneous coronary intervention (PCI) or thrombolysis for ST-elevation myocardial infarction (STEMI).

Long-term Management

• Lifestyle modifications including diet, exercise, and smoking cessation.
• Statins to lower cholesterol levels.
• ACE inhibitors or angiotensin receptor blockers (ARBs) for patients with heart failure or reduced ejection fraction.
• Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor.

Prognosis

The prognosis of acute coronary syndrome varies depending on the extent of myocardial damage, the timeliness of treatment, and the presence of comorbid conditions. Early intervention and adherence to treatment guidelines improve outcomes.

Related Pages

• Myocardial infarction
• Unstable angina
• Coronary artery disease
• Cardiac arrest

• 
  Diagram illustrating a heart attack.
• 
  Scheme of acute coronary syndrome.