Acute Coronary Syndrome

Acute Coronary Syndrome (ACS) encompasses conditions associated with sudden, reduced blood flow to the heart muscle. It usually includes myocardial infarction (heart attack) and unstable angina. ACS is a medical emergency that requires immediate attention to limit damage to the heart muscle and prevent severe complications or death.

Epidemiologically, acute coronary syndrome is one of the leading causes of death worldwide. According to the World Health Organization, cardiovascular diseases cause approximately 17.9 million deaths annually, with a significant portion attributed to ACS. Risk factors include age, gender (men are more prone), hypertension, high cholesterol, smoking, sedentary lifestyle, obesity, diabetes, and a family history of cardiovascular diseases.

The pathophysiology of acute coronary syndrome primarily involves atherosclerosis, a condition where atheromatous plaques accumulate in the arterial walls. When these plaques rupture, a blood clot forms that can partially or completely block blood flow in the coronary arteries. This leads to myocardial ischemia, and if blood flow is not restored quickly, myocardial necrosis (myocardial infarction) occurs.

The primary causes of acute coronary syndrome include atherosclerosis, rupture of atheromatous plaques, blood clots, and, less commonly, coronary artery spasm. Risk factors exacerbate the development and worsening of these causes.

Symptoms of acute coronary syndrome include chest pain or discomfort, often described as pressure, squeezing, or burning. The pain can radiate to the neck, jaw, shoulders, back, or upper arms. Other symptoms include shortness of breath, nausea, sweating, weakness, dizziness, or fainting. Differential diagnosis of ACS is essential to distinguish it from other conditions that can cause similar symptoms, such as pulmonary embolism, acute pericarditis, aortic aneurysm, and gastrointestinal problems.

Complications of acute coronary syndrome can be severe and include heart failure, cardiac arrhythmias, cardiogenic shock, and sudden cardiac arrest. Prompt recognition and management of ACS are critical to avoiding these complications.

The treatment of acute coronary syndrome depends on its severity and type. It includes medication such as antiplatelet agents (aspirin, clopidogrel), anticoagulants (heparin), nitrates, beta-blockers, and angiotensin-converting enzyme inhibitors (ACE inhibitors). In some cases, invasive procedures like angioplasty or coronary artery bypass grafting (CABG) are required.

Laboratory tests are crucial for diagnosing and managing acute coronary syndrome. The primary lab tests include measuring cardiac enzymes and markers. Troponin-T is the most sensitive and specific marker for myocardial injury, increasing within a few hours of the infarction onset. Other markers include creatine kinase-MB (CK-MB) and myoglobin, although they are less specific than troponin. Additionally, patients undergo electrocardiograms (ECG) to detect ischemic changes, such as ST-segment elevation or depression. Blood tests for lipids and glucose are also crucial for assessing risk factors.

After initial management, monitoring patients with acute coronary syndrome involves regular clinical evaluation and repeat laboratory tests to monitor cardiac markers and function. Managing and controlling risk factors like hypertension, hyperlipidemia, and diabetes is also essential to prevent future cardiac events.

This article belongs to a new series on our blog that covers all fields of health! We present information on the most frequent pathological conditions in a comprehensive, clear, understandable, but always scientifically documented way so you can know and protect the most crucial good: your health!

Ioannis Sideris, Medical Doctor