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Acute Coronary Syndrome

(ACS; Unstable Angina)

Definition

Acute coronary syndrome (ACS) is a set of features related to poor blood flow to the heart muscle that leads to a heart attack. This results in chest pain or angina pectoris. ACS is a serious, life-threatening condition. If you think you have ACS, seek emergency medical treatment.

Causes

ACS is caused by a sudden blockage of the coronary arteries. These blood vessels carry blood to the heart muscle. The blood flow to the heart muscle is either greatly reduced or completely blocked. This leads to heart muscle damage or death from a heart attack.
The narrowing most often happens from years of plaque build-up in an artery. This is called atherosclerosis . Blood clots may often cause of the narrowing arteries.
Coronary Artery
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Risk Factors

ACS is more common in men over 45 and women over 55 years old.
Factors that increase your risk of developing ACS include:
  • A family history of heart disease
  • Being overweight or obese
  • Smoking
  • High cholesterol , especially high LDL ("bad") cholesterol, high triglycerides, and low HDL (“good”) cholesterol
  • High blood pressure
  • Diabetes
  • Inactivity
  • Having angina, a previous heart attack, or other types of coronary artery disease

Symptoms

ACS is serious. It requires emergency medical treatment. Contact your doctor if you have any of these symptoms:
  • Chest pain, pressure, tightness, burning, or other discomfort that may last a few minutes, go away, and then come back
  • Pain that lasts 30 minutes or longer
  • Pain that occurs after physical exertion, emotional stress, or eating a large meal
  • Pain that occurs at rest, while sleeping, or with little exertion
  • Pain or discomfort in one or both arms, shoulders, the back, the neck, jaw, or stomach
  • Shortness of breath combined with chest pain
  • Lightheadedness
  • Nausea and vomiting
  • Sweating

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. If you suspect ACS, call for emergency medical services.
Your bodily fluids may need to be tested. This can be done with blood tests.
Your heart function may need to be tested. This can be done with:
Detailed images of your heart may need to be taken. These can be done with:

Treatment

If you are having a heart attack, doctors will:
  • Work quickly to restore blood flow to the heart
  • Closely monitor vital signs to detect and treat complications
To restore blood flow, the main treatments are:
  • Aspirin is given to all patients suspected of having ACS.
  • Anti-ischemic drugs, such as nitroglycerin are used to help relieve chest pain.
  • Beta blockers are given to slow the heart rate so it does not use too much energy.
  • Thrombolytic drugs are used to dissolve blood clots. When given soon after a heart attack begins, these drugs can limit or prevent permanent damage to the heart. To be most effective, they need to be given within one hour after the start of heart attack symptoms.
  • Platelet inhibitors to keep the blockage from getting worse.
  • Angioplasty —a catheter is inserted into a blocked artery. A balloon is inflated and deflated. This will allow blood to flow again. A stent may be placed to prop the artery open.
  • Coronary artery bypass surgery —arteries or veins are taken from other areas in your body. They are used to bypass the blocked arteries in your heart.
  • Oxygen is given to all patients.

Prevention

To help reduce your chances of getting ACS:
  • Eat a well-balanced diet that is low in saturated fats. The diet should also be rich in fruits, vegetables, and whole grains.
  • Exercise regularly.
  • If you smoke, talk to your doctor about ways to quit .
  • Manage your diabetes, blood pressure, and cholesterol. This can include lifestyle changes and medication.

RESOURCES

American College of Cardiology http://www.cardiosource.org

American Heart Association http://www.heart.org

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

References

Achar SA, Kundu S, et al. Diagnosis of acute coronary syndrome. Am Fam Physician. 2005; 72:119-26.

Acute coronary syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 15, 2014. Accessed August 11, 2014.

Alexander KP, Newby LK, et al: Acute Coronary Care in the Elderly, Part I. Circ . 2007;115:2549-69.

Anderson JL, Adams CD, et. al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. J Am Coll Cardiol. 2007;50;e1-e157.

Cohen M, Diez JE, et al. Pharmacoiinvasive management of acute coronary syndrome: incorporating the 2007 ACC/AHA guidelines: the cATH (cardiac catherization and antithrombotic therapy in the hospital) Clinical Consensus Panel Report-III. J Invasive Cardiol. 2007:18:525-40.

Heart attack: Tips for recovering and staying well. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/heart-attack/treatment/tips-for-recovering-and-staying-well.html. Updated March 2014. Accessed August 11, 2014.

Large GA. Contemporary management of acute coronary syndrome. Postgrad Med J. 2005; 81:217-222.

Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA. 2005;294:2623-9.

Walker CW, Dewley CA, Fletcher SF:Aspirin combined with clopidogrel (Plavix) decreases cardiovascular events in patients with acute coronary syndrome. Am Fam Physician. 2007;7:1643-5.

What is angina? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Angina/Angina%5FTreatments.html. Updated June 1, 2011. Accessed August 11, 2014.

7/7/2007 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: O'Donoghue M, Boden WE, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2008;300:71-80.

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