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Acute Coronary Syndrome: Causes, Symptoms, Treatment and Prevention

Acute coronary syndrome refers to the conditions that can cause sudden blockage or reduce blood supply to the muscles of heart. Acute coronary syndrome requires immediate medical intervention. Once the diagnosis of acute coronary syndrome is confirmed, patient may receive immediate treatment which may include certain medical procedures, such as cardiac catheterization or angioplasty.

Acute coronary syndrome can be differentiated from stable angina by determining the pattern of chest pain. In patients with stable angina, the chest pain may occur due to physical exertion, whereas in acute coronary syndrome the pain occurs even at rest. Moreover, pain associated with acute coronary syndrome originating from chest radiates to other parts of the body, such as back, neck, jaws, and arms.

Acute Coronary Syndrome

Classification

Acute coronary syndrome is classified based on the presence of serum markers, symptoms, and electrocardiography results. Acute coronary syndrome can be categorized as follows:

Unstable Angina: Unstable angina refers to a change in the pattern of symptoms that include persistent or worsening angina and the onset of severe angina symptoms. Individuals with angina may not have any signs of heart damage on their blood tests or electrocardiogram.

 Non-ST-Segment Elevation Myocardial Infarction (NSTEMI): The blockage in the artery may be temporary and the damage is relatively small in NSTEMI. This type of myocardial infarction can be identified by assessing the biomarkers through blood tests, but electrocardiogram may not show any changes.

ST-Segment Elevation Myocardial Infarction (STEMI):STEMI can be caused due to prolonged blockage of the blood flow to the heart leading to ischemia.  Changes in the chemical markers of the blood and on the ECG are evident.

Symptoms

  • Sudden chest pain
  • Shortness of breath
  • Dizziness or light-headedness
  • Nausea
  • Excessive sweating
  • Fast or irregular heartbeat

Causes

The heart muscles requires a continuous supply of oxygen-rich blood. Coronary artery delivers blood to the heart muscle.  A block in the coronary artery, may reduce the blood supply to the heart muscle, thereby causing acute coronary syndrome. If there is a reduction in the blood supply for more than a few minutes, the heart tissue can die resulting in heart attack.

Formation of blood clot in the coronary arteries is the primary cause of coronary artery blockage. In most of the cases, narrowing of an artery may result from the buildup of cholesterol and free fatty acids in the arterial wall (known as atheroma). Rupture of atheroma causes the release of substances that promotes clot formation. In most of the people, the blood clot dissolves by itself within a day or two.

In rare conditions, the clot formed in the heart lodges in coronary artery causing a heart attack. Another cause of heart attack may include spasm of the coronary artery.

Risk Factors

Conditions that may increase the risk of acute coronary syndrome:

  • Increasing age
  • High blood pressure
  • High blood cholesterol
  • Smoking
  • Sedentary lifestyle
  • Being obese or overweight
  • Unhealthy food habits
  • Diabetes
  • Family history of heart disease

Complications

Conditions that can arise due to acute coronary syndrome:

  • Abnormal blood pumping the heart
  • Arrhythmias
  • Pericarditis
  • Dressler syndrome
  • Myocardial rupture
  • Ventricular aneurysm
  • Mitral valve regurgitation

Diagnosis and Treatment

Interventions

An acute coronary syndrome is an emergency and requires immediate medical treatment.

  • Blood Tests: Certain serum markers may be present in the blood if heart tissue damage has resulted in cell death. Positive result shows the heart attack.
  • Electrocardiogram: Helps to measure the electrical activity of the heart. Abnormal electrical impulses may indicate poor functioning of the heart. This test might be repeated several times to confirm the diagnosis and determine the treatment efficacy.

Blood tests, electrocardiogram, and symptoms provide the primary basis for diagnosing acute coronary syndrome. Other tests may be advised to further confirm the diagnosis and rule out any other possible causes of the symptoms.

  • Coronary Angiogram: Uses X-ray imaging to visualize the blood vessels of the heart.
  • Echocardiogram: Uses sound waves to produce the images of the heart; this test helps in determining the pumping ability of the heart.
  • Myocardial Perfusion Imaging: Helps to identify the blood flow to the heart muscle.
  • Computerized Tomography Angiogram: It is an advanced form of X-ray which produces cross-sectional images of the heart. This test can detect blockage or narrowing of the blood vessels.

Medications

The treatment goal is to improve the blood flow to the heart, reduce pain and distress, and restore the heart function.  Following medications may be prescribed.

  • Thrombolytics – To dissolve the clot which is blocking an artery
  • Nitroglycerin – To improve the blood circulation by temporarily widening the blood vessels
  • Antiplatelet drugs – To prevent the formation of blood clots
  • Beta-blockers – To relax the heart muscle and slow down the heart rate
  • Angiotensin-converting enzyme inhibitors – To dilate the blood vessels and improve the blood flow to the heart
  • Angiotensin receptor blockers – To control blood pressure
  • Statins – To lower the amount of cholesterol in the blood

Surgery

In severe cases, surgical interventions such as percutaneous coronary intervention and coronary artery bypass grafting (CABG) may be needed.

Diet

The following dietary modifications may help prevent another episode of acute coronary syndrome:

  • Salt or sodium containing food products should be avoided, as they can cause constriction of the blood vessels and increase the workload of the heart.
  • Food products containing high sugars such as energy drinks, sodas, sweetened coffee, tea, cakes, candies, and ice cream should be limited. Excess amount of sugar can cause damage to the blood vessels.
  • High saturated fat containing food products like fatty meats, butter, lard, whole-milk dairy, palm and coconut oils should be consumed in lesser quantities, as they can increase the cholesterol levels in the body resulting in obstruction of blood vessels.
  • Alcohol should not be consumed more than one to two drinks per day. Drinking more alcohol can raise the blood pressure.

Remedies

The following home remedies can help to decrease the risk of acute coronary syndrome:

  • Consume fish rich in omega-3 fatty acids fish as it helps improve heart health and decrease the risk of acute coronary syndrome.
  • Include onions and garlic in your diet. They help in decreasing the levels of bad cholesterol (LDL) and increasing the levels of good cholesterol (HDL) in the blood.
  • Add nuts like peanuts, almonds, cashews, pistachios, flax seeds, and walnuts to the diet as they are rich in antioxidants.
  • Eat adequate amounts of fruits and vegetables; they are rich in minerals, fibers, and vitamins and help in decreasing the risk of acute coronary syndrome.
  • Choose DASH (Dietary Approach to Stop Hypertension) diet plan to improve the heart health.
  • Practice meditation and yoga for stress management.

Prevention

Specific measures should be followed to prevent heart attack and promote overall quality of life. These measures include:

  • Smoking cessation
  • Regular exercising and staying active
  • Monitoring of blood cholesterol levels
  • Maintaining a healthy weight

FAQs

1. Can acute coronary syndrome impact the psychological state of an individual?

Yes. Research indicates high risk of depression in individuals who had an episode of acute coronary syndrome.

2. What are the cardiac markers used in the diagnosis of acute coronary syndrome?

Cardiac markers that have a diagnostic value in acute coronary syndrome include cardiac troponin, myoglobin, and creatine kinase MB (CK-MB). They provide optimal accuracy and sensitivity in the diagnosis of acute coronary syndrome.

3. I am a 62-year old suffering from asthma, what are the chances of me having acute coronary syndrome?

Research indicates that poorly-managed asthma increases the risk of developing acute coronary syndrome.

4. I am a 66-year-old woman; what form of physical activity should I perform to reduce the risk of acquiring acute coronary syndrome?

The risk of acquiring any heart disease increases with increasing age; people who are 65 years or above are at increased risk of suffering from any heart disease. They should try doing activities like brisk walking, cycling, dancing or gardening. Performing at least 150 minutes of exercise every week can help in keeping the heart healthy.

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