Acute Coronary Syndrome (ACS)

Introduction

Acute Coronary Syndrome (ACS) refers to a group of conditions that are associated with sudden, restricted blood flow to the heart. It includes unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). This is a medical emergency requiring immediate attention.

Causes of ACS

The primary cause of ACS is atherosclerosis—the buildup of fatty deposits (plaque) inside coronary arteries. When a plaque ruptures, it can cause a blood clot, reducing or completely blocking blood supply to the heart.

Symptoms

  • Chest pain or discomfort (pressure, tightness, heaviness)
  • Radiation of pain to the left arm, jaw, neck, or back
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Dizziness or fainting

Diagnosis

Doctors use several diagnostic tests: - Electrocardiogram (ECG): Identifies ST-segment changes (STEMI vs. NSTEMI/UA) - Blood tests (Troponin levels): Detects cardiac muscle damage - Coronary angiography: Evaluates artery blockages

Treatment Strategies

Immediate Measures

  • Oxygen therapy, if necessary
  • Pain relief (morphine in severe cases)
  • Aspirin (prevents further clot formation)
  • Nitroglycerin (relieves chest pain)

    Reperfusion Therapy

  • Percutaneous Coronary Intervention (PCI) (angioplasty with or without stent placement)

  • Fibrinolytic Therapy (clot-dissolving medications in STEMI if PCI is not available)

    Long-term Management

  • Antiplatelet drugs (Aspirin, P2Y12 inhibitors like Clopidogrel)

  • Beta-blockers (reduce heart workload)
  • ACE inhibitors (improve heart function)
  • Statins (lower cholesterol and stabilize plaques)
  • Lifestyle changes (diet, smoking cessation, exercise)

Prevention of ACS

  • Maintain a healthy diet rich in fruits, vegetables, and whole grains
  • Control high blood pressure and cholesterol levels
  • Engage in regular exercise
  • Quit smoking
  • Manage diabetes effectively

Conclusion

ACS is a life-threatening condition, but timely diagnosis and proper treatment significantly improve survival and reduce complications. If you experience symptoms, seek medical attention IMMEDIATELY.

Source recommendations

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

  1. https://www.acc.org/Guidelines
  2. https://www.ahajournals.org/doi/10.1161/cir.0000000000000134
  3. https://pubmed.ncbi.nlm.nih.gov/25260718/
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
  5. https://pubmed.ncbi.nlm.nih.gov/40014670/

2. European Society of Cardiology (ESC) Guidelines on 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://academic.oup.com/eurheartj/article/42/14/1289/5898842
  5. https://pubmed.ncbi.nlm.nih.gov/32860058/

3. National Institute for Health and Care Excellence (NICE) Guidelines on Acute Coronary Syndrome

  1. https://www.nice.org.uk/guidance/ng185
  2. https://bnf.nice.org.uk/treatment-summaries/acute-coronary-syndromes/
  3. https://www.nice.org.uk/guidance/ng185/resources/acute-coronary-syndromes-pdf-66142023361477
  4. https://pubmed.ncbi.nlm.nih.gov/33301270/
  5. https://www.ncbi.nlm.nih.gov/books/NBK11822/

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