Acute Coronary Syndrome (ACS)

Introduction

Acute Coronary Syndrome (ACS) is a medical emergency that includes conditions such as unstable angina, non-ST elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). These conditions arise due to a sudden reduction in blood flow to the heart muscle, primarily caused by plaque rupture and thrombus formation in the coronary arteries.

Causes and Risk Factors

Major Causes:

• Rupture of an atherosclerotic plaque leading to thrombus formation.
• Coronary artery spasm leading to transient ischemia.
• Microvascular dysfunction reducing blood supply to the heart muscle.

Risk Factors:

• Modifiable Factors: Smoking, high blood pressure, high cholesterol, diabetes, obesity, sedentary lifestyle, and poor diet.
• Non-Modifiable Factors: Age, gender (more common in men), family history of heart disease, and genetic predisposition.

Symptoms of ACS

• Chest pain (angina): A pressing or squeezing discomfort that may radiate to the arm, neck, jaw, or back.
• Shortness of breath: A feeling of breathlessness even at rest or during mild exercise.
• Sweating and nausea: Often associated with myocardial ischemia.
• Dizziness or fainting: Due to insufficient oxygen supply to the brain.
• Fatigue: Especially in women, this can be an early and subtle sign.

Diagnosis

• Electrocardiogram (ECG): A primary tool to differentiate between STEMI and NSTEMI/unstable angina.
• Blood tests (Troponins): Elevated levels indicate myocardial damage.
• Echocardiogram: Assesses heart muscle function and identifies complications like heart failure.
• Coronary Angiography: A gold standard test to identify blocked arteries in high-risk patients.

Treatment and Management

Emergency Treatment:

• Aspirin: Prevents further thrombus formation.
• Nitroglycerin: Relieves chest pain by dilating coronary arteries.
• Oxygen Therapy: Given if oxygen levels are low.
• Pain relief (Morphine): In severe cases.

Definitive Treatments:

• Percutaneous Coronary Intervention (PCI): A stent is placed to open a blocked artery, especially in STEMI cases.
• Coronary Artery Bypass Grafting (CABG): Surgery for severe multi-vessel disease.
• Medications: Beta-blockers, ACE inhibitors, statins, and dual antiplatelet therapy (DAPT) are essential for long-term management.

Prevention Strategies

• Maintaining a heart-healthy diet (Mediterranean diet preference).
• Regular physical activity (at least 150 minutes per week of moderate exercise).
• Strict control of blood pressure, cholesterol, and diabetes.
• Quitting smoking and managing stress effectively.
• Adherence to prescribed medications post-ACS to prevent recurrence.

Conclusion

ACS requires immediate medical intervention as delayed treatment can lead to severe complications such as heart failure, arrhythmias, or sudden cardiac death. Patients should recognize symptoms early and seek medical help without delay. Long-term lifestyle modifications and medication adherence are crucial to improving outcomes and preventing future cardiovascular events.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Management of Patients with Acute Coronary Syndromes

1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000134
2. https://www.acc.org/Guidelines
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
4. https://pubmed.ncbi.nlm.nih.gov/40013746/
5. https://newsroom.heart.org/news/acc-aha-issue-new-acute-coronary-syndromes-guideline

2. European Society of Cardiology (ESC) Guidelines for the Management of Acute Coronary Syndromes

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Coronary-Syndromes-ACS-Guidelines
2. https://academic.oup.com/eurheartj/article/44/38/3720/7243210
3. https://pubmed.ncbi.nlm.nih.gov/37622654/
4. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2023/08/29/14/01/2023-esc-guidelines-acs-esc-2023
5. https://pubmed.ncbi.nlm.nih.gov/26320110/