Acute Coronary Syndrome (ACS)

Introduction

Acute Coronary Syndrome (ACS) is a group of conditions associated with a sudden, reduced blood flow to the heart. It includes: - Unstable Angina (UA) - Non-ST-Elevation Myocardial Infarction (NSTEMI) - ST-Elevation Myocardial Infarction (STEMI)

Causes and Risk Factors

ACS is caused by the rupture of an atherosclerotic plaque in a coronary artery, leading to thrombus (blood clot) formation. Risk factors include: - Hypertension - Diabetes Mellitus - Smoking - High Cholesterol - Obesity - Family History of Heart Disease

Symptoms

Key symptoms include: - Chest pain or discomfort (pressure, squeezing, or burning) - Radiating pain (to the jaw, neck, arms, or back) - Shortness of breath - Sweating - Nausea or vomiting

Diagnosis

  • Electrocardiogram (ECG) to detect ST-segment changes
  • Blood tests, including cardiac biomarkers (Troponins)
  • Echocardiogram for heart function assessment
  • Coronary angiography to visualize artery blockages

Treatment

Treatment depends on the type of ACS but generally includes:

Immediate Management (MONA-B)

  • Morphine (for pain relief)
  • Oxygen (if needed)
  • Nitrates (to relieve chest pain)
  • Aspirin (to prevent clot growth)
  • Beta-blockers (to reduce heart workload)

Long-Term Treatment

  • Antiplatelet therapy (Aspirin, P2Y12 inhibitors)
  • Statins (to lower cholesterol)
  • Beta-blockers & ACE inhibitors (to improve heart function and prevent recurrence)
  • Lifestyle modifications (diet, exercise, quitting smoking)

Revascularization

  • Percutaneous Coronary Intervention (PCI) with stent placement
  • Coronary Artery Bypass Graft (CABG) for severe cases

Prevention

  • Regular exercise
  • Heart-healthy diet
  • Controlling blood pressure and blood sugar
  • Avoiding smoking and alcohol abuse

Conclusion

Early recognition and treatment of ACS are crucial to improving survival and reducing complications. If you experience chest pain or discomfort, seek emergency care immediately.

Source recommendations

1. American Heart Association Guidelines for the Management of Acute Coronary Syndromes

  1. https://www.ahajournals.org/doi/10.1161/cir.0000000000000134
  2. https://pubmed.ncbi.nlm.nih.gov/25260718/
  3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
  4. https://professional.heart.org/en/guidelines-statements
  5. https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks/acute-coronary-syndrome

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/

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