Acute Coronary Syndrome

Acute coronary syndrome is a term given by doctors for various heart conditions, including myocardial infarction (heart attack) and unstable angina. These are because there is a reduced amount of blood flowing to a part of the heart. Various treatments are given and these usually depend on the type of acute coronary syndrome. The treatments help relieve pain, improve blood flow and to prevent future complications.

On this page

• What is acute coronary syndrome?
• Understanding the coronary arteries of the heart and
• What happens in acute coronary syndrome?
• What causes acute coronary syndrome?
• Who is at risk for acute coronary syndrome?
• What are the symptoms of acute coronary syndrome?
• What tests are done?
• What is the treatment for acute coronary syndrome?
• Treatment after having had an acute coronary syndrome
• After an acute coronary syndrome
• Other sources of information and help
• References

What is acute coronary syndrome?

The term acute coronary syndrome (ACS) encompasses a wide range of disorders, including myocardial infarction (heart attack) and unstable angina are caused by the same underlying problem.

The underlying problem is a sudden reduction of blood flow to a part of the heart muscle. This is usually caused by a blood clot that forms on a piece of atheroma in a coronary artery (described below).

The types of problems ranging from unstable angina – when the blood clot causes a reduction of blood flow, but not a total blockade whereby the cardiac muscle supplied by the affected artery infarct not (die) – to myocardial infarction actual (MI).

The location of the blockage, the amount of time that blood flow is blocked, and the amount of damage that occurs to determine the type of acute coronary syndrome.

Understanding the coronary arteries of the heart and

The heart muscle is composed primarily of special. The heart pumps blood into the arteries (blood vessels) that carry blood to all parts of the body.

Like any other muscle, the heart muscle needs a good blood supply. The coronary arteries take blood to the heart muscle. Coronary arteries main branches of the aorta. The aorta is the large artery that carries oxygen-rich blood from the heart chambers to the body. The main coronary arteries divide into smaller branches that carry blood to all parts of the heart muscle.

What happens in acute coronary syndrome?

ACS is from MI to unstable angina.

A heart attack?

If you have an MI, a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart muscle supplied by that artery loses its blood (and oxygen). This part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word means death of myocardial tissue part due to the blockage of an artery that prevents blood from getting past.) MI is sometimes called a heart attack or a coronary thrombosis.

There are different types of MI based on what you see in the study of the heart (also called an electrocardiograph (ECG)). The two main types are called ST segment elevation MI (STEMI) and non-ST elevation MI (NSTEMI). In a STEMI, the artery supplying an area of heart muscle is blocked completely. However, in one NSTEMI, the artery is partially blocked, so that only part of the heart muscle being supplied by the affected artery is affected.

Unstable angina

Unstable angina occurs when a blood clot causes a reduction of blood flow, but no total blocking. This means that the heart muscle being supplied by the affected artery infarction not (die).

Note: This article describes NSTEMI and unstable angina only. For information on STEMI, see separate leaflet called 'myocardial infarction (heart attack). "

What causes acute coronary syndrome?

Most of the cases is that there is a narrowing in the blood vessels that supply the heart. This is usually due to the presence of something of atheroma in the artery walls. Atheroma is as patches or fatty plaques develop on the inner lining of the arteries. (This is similar to the water pipes furred up.)

Plaques can form gradually over a number of years in one or more places in the coronary arteries. Each plate has an outer layer with a soft core firm inner fatty. Atheroma leads to narrowing of the blood vessels.

Several other rare conditions can also block a coronary artery. For example, the inflammation of the coronary arteries (rare) – a stab wound at the heart-blood clots in other parts of the body (for example, in a chamber of the heart) and travel to a coronary artery, which is stuck making cocaine, which can cause a coronary artery to go into spasm complications of heart surgery and some other rare heart problems. These are discussed later in this booklet.

Who is at risk for acute coronary syndrome?

ACS is common. About 114,000 people in the UK are admitted to hospital each year with ACS. Most occur in people over 50 years and become more common with age. Sometimes young people are affected.

Risk factors for a SCA are actually the same as the risk factors of having a heart attack or cardiovascular disease. See separate leaflet called 'Preventing Cardiovascular Disease, "which discusses this in more detail.

In short, the risk factors that can be modified and may help prevent SCA are:

• High blood pressure. If your blood pressure is high, it can be treated.
• If you are overweight, losing some weight is recommended. Weight loss reduces the workload of the heart and also help lower blood pressure.
• A high cholesterol level. This should usually be treated if it is high.
• Inactivity. You should try to do some moderate physical activity most days of the week for 20-30 minutes. For example, brisk walking, swimming, cycling, dancing, gardening, etc.
• Diet. You should try to eat a healthy diet.
• Diabetes. People with diabetes have a higher risk of having ACS. This risk can be reduced by ensuring that their blood pressure, cholesterol and glucose levels are within normal limits.
• Family history. Your risk is increased if a family history of heart disease or stroke occurred in a parent or sibling under age 55, or your mother or sister 65 years of age.
• Race. Certain ethnic groups, such as British Asians, have a higher risk of cardiovascular disease.

What are the symptoms of acute coronary syndrome?

The most common symptom of ACS has severe chest pain. The pain often feels like a heavy pressure on the chest. The pain may also travel to the jaw and left arm or both arms. You may also sweat, feel sick and feel weak. You may also feel short of breath.

The pain may be similar to an attack of stable (normal) angina, but usually more severe and lasts longer. (In people with stable angina, angina pectoris, pain usually goes away after a few minutes the pain ACS usually lasts more than 15 minutes – sometimes several hours ..)

Some people with ACS has no chest pain, especially those who are elderly or who have diabetes.

What tests are done?

Sometimes it can be difficult for doctors to distinguish between ACS and other causes of chest pain. If suspected ACS, then it should be referred urgently to a hospital. On admission to hospital, several tests were performed. These include:

• A heart tracing called an electrocardiograph (ECG). There may be changes in the normal pattern typical heart tracing if you have a SCA. However, a normal ECG can also in some cases.
• Blood tests. A blood test that measures a chemical called troponin is the usual test is done. This chemical is present in the heart muscle cells. Damage to the heart muscle cells releases troponin into the bloodstream. The troponin level is raised if you have a heart attack, but not elevated in unstable angina.

His study of the heart can be monitored for a few days to check the heart rate. Several blood tests will be done to verify its general welfare. Other tests may also be done in some cases. This may be to clarify the diagnosis (if the diagnosis is uncertain) or to diagnose complications such as heart failure if this is suspected. For example, an echocardiogram (ultrasound of the heart).

Also, before discharge, you may be advised to have tests to assess the severity of coronary artery atheroma. These tests are similar to those used to assess the severity of angina and are discussed in more detail in the booklet Angina.

What is the treatment for acute coronary syndrome?

SCA treatment varies between cases. The MI are treated differently from unstable angina. Treatments may vary depending on the situation.

If you have had a STEMI then treats him like those who have had a myocardial infarction (again, see separate leaflet called 'myocardial infarction (heart attack) "for details). Treatment of those with unstable angina or NSTEMI two phases: pain relief and the prevention of the progression of, or limit the scope of a myocardial infarction.

Its treatment usually varies depending on their risk rating. This is a risk score of myocardial infarction in the future. Several factors are considered in this rating, including your age, other risk factors for cardiovascular disease (eg, if you smoke, have high cholesterol or have high blood pressure or diabetes), the results of the blood tests and what your EKG looks like the first time attending the hospital.

Aspirin and other antiplatelet drugs

As soon as possible after a suspected ACS was administered a dose of aspirin. Aspirin reduces the viscosity of platelets. Platelets are small particles in the blood causing blood clotting. These platelets are trapped in a patch of atheroma inside an artery to form the clot (thrombosis), myocardial infarction.

Other antiplatelet drug clopidogrel is also sometimes called is given. This works in a different way to aspirin and adds to the action of reducing platelet stickiness. Usually given with aspirin if there is a change in heart rate or troponin level is raised in your blood. In some cases there is as an alternative to aspirin (for example, if an allergy to aspirin).

Injections of heparin or a similar drug

These are usually given for a few days to help prevent blood clots forming new.

Pain Relief

A strong painkiller given by injection into a vein is given to relieve pain.

Glycoprotein IIb / IIIa receptor antagonist

If doctors think that you have a high risk for a heart attack so they can give you a medicine called glycoprotein IIb / IIIa receptor antagonist. This can help relieve pain and also works to reduce the chances of blood clots that completely block arteries. This medicine is given to you as a drip directly into their veins. This medicine is also used if you are going to have a treatment to help the dilation of the arteries (eg, angioplasty – see below).

The treatment to restore blood flow in the blocked coronary artery

The part of the heart muscle deprived of blood dies (infarction) immediately during an IM. If blood flow is restored within a few hours, most of the heart muscle is damaged survive. This is why the MI is a medical emergency and urgent treatment is given. The faster the blood flow is restored, the better the prognosis.

Not all cases require treatment. However, for some people this is the most appropriate treatment. There are two treatments that can be done to restore blood flow through the blocked artery:

• Emergency angioplasty is, ideally, the best treatment if available and can be done within a few hours of onset of symptoms. In this procedure, a small wire with a balloon at the tip is placed in a large artery in the groin or arm. It then goes to the heart and the blocked section of a coronary artery, using special X-ray guidance. The balloon is inflated inside the blocked artery to open wide again. A stent may be placed in the enlarged section of the artery. A stent is a wire mesh tube that supports the artery and helps keep the artery widened. See separate leaflet called 'Coronary Angioplasty' for details.

• An injection of an anticoagulant drug is an alternative to the emergency angioplasty. In fact, this is the most common treatment, since it can easily and quickly apply in most situations. Some ambulances are trained to provide this treatment. Note: A common clot-buster drug used in the UK is called streptokinase. If you are given this medicine should not be given back if you have another heart attack in the future. This is because antibodies are developed to the same and does not work as well a second time. An alternative clot-buster drug should be given if you have another heart attack in the future.

A beta-blocker drug

Beta-blocking drugs block the action of certain hormones, such as adrenaline. These hormones increase the speed and force of the heartbeat. Drug beta-blockers have a protective effect on the heart muscle and also help prevent abnormal heart rhythms become. A beta-blocker medication will also help reduce the risk of having a heart attack in the future.

Insulin

Some people have a high level of blood sugar when they have a SCA, even if you have diabetes. If this occurs, then the levels of blood sugar may need to be controlled with insulin. If you have diabetes, then you probably also have to be treated with insulin to control glucose levels in the blood when in the hospital.

Oxygen

You may be given oxygen that works to reduce the risk of damage to the heart muscle.

Treatment after having had an acute coronary syndrome

Once you have had an ACS, usually advised to take regular medication for the rest of his life. Longterm drug is designed to reduce the risk of future myocardial infarction and therefore is recommended if you have had unstable angina, and if you have had a heart attack. See separate leaflet called 'Myocardial Infarction – Medication after the MI "which discusses this further.

In summary, the following four drugs are commonly prescribed to prevent further myocardial infarction, and to help prevent complications:

• Aspirin – to reduce the viscosity of the blood platelets, which helps prevent the formation of blood clots. If you can not take aspirin then an alternative medicine clopidogrel antiplatelet as may be advised.
• A beta blocker – to decrease heart rate and to reduce the chance of developing abnormal heart rhythms.
• An angiotensin converting enzyme (ACE). ACE inhibitors have a number of actions, including having a protective effect on the heart.
• A statin drug to lower cholesterol in the blood. This helps prevent the build up of atheroma.

Many people recover well from a SCA and have no complications. Before discharge is common for a doctor or nurse will advise you on how to reduce the risk factors (see above). This advice is aimed at reducing the risk of a future ACS or MI as much as possible.

After an acute coronary syndrome

After recovering from an ACS, one wonders if there are dos and don'ts. However, regular exercise and return to normal life and work are advised. Much can be done to reduce the risk of additional ACS or MI. See separate leaflet called 'Myocardial Infarction – After the MI "which discusses this further.

Other sources of information and help

British Heart Foundation

Greater London House, 180 Hampstead Road, London NW1 7AW
Tel (Heart Helpline): 0300 330 3311 Web: www.bhf.org.uk

HEART UK (Education Hyperlipidemia and Atherosclerosis Research Trust UK)

7 North Road, Maidenhead, Berkshire SL6 1PE
Tel (Helpline): 0845 450 5988 Web: www.heartuk.org.uk

British Cardiac Patients Association

15 Abbey Road, Bingham, Notts, NG13 8EE
Tel (Helpline): 01223 846 845 Web: www.bcpa.co.uk

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