Acute Coronary Syndrome
What is acute coronary syndrome?
Acute coronary syndrome (ACS) refers to a spectrum of cardiovascular conditions characterised by a sudden decrease in blood flow to the heart muscle due to the partial or complete blockage of coronary arteries. ACS includes heart attack, unstable chest pain and stroke along with other life-threatening heart conditions. These conditions can display with varying degrees of severity and associated risks.
Causes and risk factors
The primary cause of ACS is the buildup of fatty deposits (also known as plaques) within the coronary arteries. This leads to the formation of blood clots that partially or completely obstruct blood flow. Several factors contribute to the development of ACS, including:
- Atherosclerosis: The buildup of plaque in the coronary arteries, often exacerbated by high cholesterol, hypertension, smoking and diabetes.
- High blood pressure (hypertension): Prolonged high blood pressure can damage artery walls and increase the risk of plaque rupture.
- Smoking: Tobacco smoke contains chemicals that accelerate the formation of atherosclerosis plaques and increase the risk of clot formation.
- Diabetes: Poorly controlled diabetes is associated with endothelial dysfunction and increased platelet aggregation, contributing to the development of ACS.
- Family history: Genetics play a role in predisposing people to ACS with a family history of heart disease being a significant risk factor.
- Obesity: Excess weight (particularly abdominal obesity) is associated with an increased risk of ACS and related complications.
Symptoms
ACS symptoms can typically appear suddenly and may include:
- Nausea or vomiting
- Dizziness and light-headedness
- Chest pain or discomfort (often severe)
- Sudden and heavy sweating
- Pain in the jaw, neck, back or stomach
- Chest pressure when resting
- Shortness of breath
- Unexplained fatigue
- Racing heartbeat
Why is acute coronary syndrome dangerous?
This condition is a medical emergency requiring immediate attention. It results in decreased blood flow to the heart, potentially leading to tissue damage or cell death. This impairment can permanently weaken the heart's function and elevate the risk of future heart-related complications. Even if it doesn't result in cell death, the condition alters heart function which significantly increases the risk of a heart attack.
Diagnosis
Diagnosing ACS requires a comprehensive approach involving various diagnostic tests. Here are the main methods used in diagnosing ACS:
An ECG is often the initial test performed as it records the heart’s electrical activity and can detect characteristic changes. ECG findings can provide valuable information about the extent and location of coronary artery blockages.
Biomarkers such as cardiac troponins and creatine kinase-MB (CK-MB) are released into the bloodstream when the heart muscle is damaged. Elevated levels of these biomarkers are indicative of a heart attack. Serial measurements of cardiac biomarkers are often performed to confirm the diagnosis and monitor for ongoing myocardial damage.
This procedure is performed to visualise any blockages or narrowing in the arteries. Coronary angiography can identify the location, severity, and extent of coronary artery disease, guiding treatment decisions such as angioplasty or bypass surgery.
In cases where ACS is suspected but initial ECG and biomarker results are inconclusive, a stress test may be performed to provoke ischemic symptoms and detect abnormalities in heart function. Exercise stress testing involves monitoring the heart's response to physical exertion on a treadmill or stationary bicycle, while pharmacological stress testing involves administering medications that simulate the effects of exercise on the heart.
Treatments
When promptly diagnosed, ACS is manageable. Treatment primarily aims to swiftly reopen the blocked artery typically administered in a hospital setting. Your treatment plan may incorporate one or more of the following approaches:
Angioplasty and stenting is minimally invasive procedure involves inserting a small mesh tube (stent) into the blocked artery to widen it and facilitate improved blood flow and oxygen delivery to the heart muscle.
Various drugs may be utilised to thin the blood, dilate blood vessels and dissolve clots particularly if emergency angioplasty is not immediately available. Medications may also be prescribed post-treatment to reduce the risk of recurrent episodes.
In some cases, a cardiologist may perform bypass surgery, grafting a new section of blood vessel onto a coronary artery containing a clot. This procedure restores blood flow by establishing a new pathway for unimpeded blood circulation.
More information
Learn more about acute coronary syndrome, its symptoms and contributing risk factors:
Consult a cardiologist
Concerned about your heart health? Contact Cardiology Specialists Melbourne, where cardiology specialists provide care and support for your heart health concerns.