Acute coronary syndrome

Acute coronary syndrome is a term for any condition that suddenly stops (or severely reduces) blood from flowing to the heart. When blood cannot flow to the heart, the heart muscle can become damaged. Heart attack and unstable angina are both acute coronary syndromes (ACS).

Causes

A fatty substance called plaque can build up in the arteries that bring oxygen-rich blood to your heart. Plaque is made up of cholesterol, fat, and other waste products.

Plaque can block blood flow in 2 ways:

• It can cause an artery to become so narrow over time that it becomes blocked enough to cause symptoms.
• The plaque tears suddenly and a blood clot forms around it, severely narrowing or blocking the artery.

Many risk factors for heart disease may lead to an ACS.

Symptoms

The most common symptom of ACS is chest pain. The chest pain may come on quickly, come and go, or get worse with rest. Other symptoms can include:

• Pain in the shoulder, arm, neck, jaw, back, or belly area
• Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching
• Discomfort that occurs at rest and does not easily go away when you take medicine
• Shortness of breath
• Anxiety
• Nausea
• Sweating
• Feeling dizzy or lightheaded
• Fast or irregular heartbeat

Women and older people often experience these other symptoms, although chest pain is common for them as well.

Exams and Tests

Your health care provider will do an exam, listen to your chest with a stethoscope, and ask about your medical history.

Tests for ACS include:

• Electrocardiogram (ECG) . An ECG is usually the first test your doctor will run. It measures your heart's electrical activity. During the test, you will have small pads taped to your chest and other areas of your body.

  Electrocardiogram (ECG)

  An electrocardiogram (ECG) is a test that records the electrical activity of the heart.

   

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• Blood test. Some blood tests help show the cause of chest pain and see if you are at a high risk for a heart attack. A troponin blood test can show if the cells in your heart have been damaged. This test can confirm you are having a heart attack.

  Troponin blood test

  A troponin test measures the levels troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damag...

   

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• Echocardiogram . This test uses sound waves to look at your heart. It shows if your heart has been damaged and can find some types of heart problems.

  Echocardiogram

  An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...

   

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Coronary angiography may be done right away or when you are more stable. This test:

• Uses a special dye and x-rays to see how blood flows through your heart.
• Can help your doctor decide which treatments you need next.

Other tests to look at your heart that may be done while you are in the hospital include:

• Exercise stress test

  Exercise stress test

  An exercise stress test is used to measure the effect of exercise on your heart.

   

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• Nuclear stress test

  Nuclear stress test

  Thallium stress test is a nuclear imaging method that shows how well blood flows into the heart muscle, both at rest and during activity.

   

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• Stress echocardiography

  Stress echocardiography

  Stress echocardiography is a test that uses ultrasound imaging to show how well your heart muscle is working to pump blood to your body. It is most ...

   

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Treatment

Your provider may use medicines, surgery, or other procedures to treat your symptoms and restore blood flow to your heart. Your treatment depends on your condition and the amount of blockage in your arteries. Your treatment may include:

• Medicine. Your provider may give you one or more types of medicine, including aspirin, beta blockers, statins, blood thinners, Angiotensin converting enzyme (ACE) inhibitors, or nitroglycerin. These medicines may help prevent or break up a blood clot, treat high blood pressure or angina, relieve chest pain, and stabilize your heart.
• Angioplasty . This procedure opens the clogged artery using a long, thin tube called a catheter. The tube is placed in the artery and the provider inserts a small deflated balloon. The balloon is inflated inside the artery to open it up. Your doctor may insert a wire tube, called a stent, to keep the artery open.

  Angioplasty

  Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary art...

   

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• Bypass surgery . This is surgery to route the blood around the artery that is blocked.

  Bypass surgery

  Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart.

   

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Outlook (Prognosis)

How well you do after an ACS depends on:

• How quickly you get treated
• The number of arteries that are blocked and how bad the blockage is
• Whether your heart is damaged and where the damage is

In general, the quicker your artery gets unblocked, the less damage you will have to your heart. People tend to do best when the blocked artery is opened within a few hours from the time symptoms start.

Possible Complications

In some cases, ACS can lead to other health problems including:

• Abnormal heart rhythms
• Heart attack
• Heart failure, which happens when the heart cannot pump enough blood

When to Contact a Medical Professional

An ACS is a medical emergency. If you have symptoms, call 911 or your local emergency number quickly.

DO NOT:

• Try to drive yourself to the hospital.
• WAIT. If you are having a heart attack, you are at greatest risk of sudden death in the early hours.

Prevention

There is a lot you can do to help prevent ACS.

• Eat a heart-healthy diet . Have plenty of fruits, veggies, whole grains, and lean meats. Try to limit foods high in cholesterol and saturated fats, since too much of these substances can clog your arteries.

  Eat a heart-healthy diet

  A healthy diet is a major factor in reducing your risk of heart disease.

   

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• Get exercise. Aim to get at least 30 minutes of moderate exercise most days of the week.
• Lose weight, if you are overweight.
• Quit smoking. Smoking can damage your heart. Ask your doctor if you need help quitting.
• Get preventive health screenings. You should see your doctor for regular cholesterol and blood pressure tests and learn how to keep your numbers in check.
• Manage health conditions, such as high blood pressure, high cholesterol, or diabetes.