What Is Acute Coronary Syndrome?

Acute coronary syndrome, or ACS, is an umbrella term for three medically serious heart ailments: unstable angina and two types of myocardial infarction or heart attack. What the three have in common is a severe reduction or stoppage of blood flow to the heart, resulting either from the rupture or blockage of the coronary arteries. Any occurrence of ACS is potentially life-threatening and should be treated as a medical emergency. This is because blood stoppage leads to rapid cell death and irreparable heart damage. Acute coronary syndrome is often indicated by the sudden onset of stabbing and spreading chest pain – the “classic” heart attack symptom. 

Heart disease in various guises remains the leading killer of Americans. If you experience ACS, go at once to the nearest medical emergency facility. If you are concerned about your heart health, or have one or more of the risk factors for heart disease, see the specialists in cardiology at Baptist Health. 

What Are the Symptoms of Acute Coronary Syndrome?

The symptoms of acute coronary syndrome include:

• Severe chest pain, or angina, that spreads to the shoulders, arms, back, and jaw
• Abnormal heartbeats (palpitations)
• Difficulty breathing
• Indigestion, nausea, and vomiting
• Dizziness or vertigo
• Heavy perspiration
• Feelings of weakness or fatigue
• A sense of dread or doom

Heart attack symptoms are typically sudden in their onset. However, some people experience minor, intermittent chest pain for many years, called stable angina, before a more serious occurrence. The stepping-up of chest pain is known medically as unstable angina. 

What Causes Acute Coronary Syndrome?

ACS is caused by the accumulation of fatty deposits or plaque in the blood vessels. These deposits restrict the flow of oxygen and nutrients to the heart. If a plaque formation ruptures and a blood clot forms, then blood flow to the heart can be shut off altogether. This stoppage results in cell death and loss of cardiac function. The most serious consequence of blood-flow blockage is a heart attack. 

Medical researchers have identified a number of risk factors for ACS. Among these are:

• Faily history of heart disease
• Being overweight
• High serum cholesterol
• Hypertension (high blood pressure)
• Elevated glucose levels, up to and including diabetes
• Poor diet
• Lack of exercise
• Cigarette smoking
• Aging

Some of these factors, such as family history and aging, are beyond your control. But many of them, including quality of diet, degree of exercise, and use of tobacco products, are based on personal choice.  

How Is Acute Coronary Syndrome Diagnosed?

Since ACS symptoms constitute a medical emergency, the best place for your condition to be diagnosed is in a hospital emergency room or similar facility. Emergency personnel will likely run one or more of the following tests to determine the precise nature of your condition:

• Blood tests: Blood tests can provide evidence for a heart attack, based on the presence of certain enzymes linked to cell death.
• Electrocardiogram or EKG: EKGs measure your heart’s electrical activity. Certain irregularities can indicate possible oxygen depletion in the muscle walls, as well as the location of the blockage. 
• Echocardiogram: Echocardiograms paint a picture of your heart using sound waves. A cardiologist can use these visual images to determine whether the heart is functioning properly.
• Computerized tomography (CT) angiogram: A CT angiogram uses X-rays to compile an image of your heart in thin, two-dimensional slices, similar to layers in a cake. This allows your medical team to determine the exact spot where a rupture or blockage exists. 
• Coronary angiogram: Coronary angiograms are another application of X-ray technology. They detect points of impasse in the bloodstream by tracking the movement of a catheter-injected dye through the body. 
• Myocardial perfusion imaging: Myocardial perfusion imaging is similar in principle to a coronary angiogram but focused on the heart. A tiny amount of radioactive material is injected into the heart, where its progress along the blood vessels is monitored by a specially designed gamma camera.  
• Stress test: A stress test measures heart performance when you exercise or after the receipt of a medicine which increases heart activity. This test is typically reserved for situations in which other tests have failed to find evidence of ACS. 

How is Acute Coronary Syndrome Treated?

The treatment focus for ACS is determining the underlying cause of the symptoms and ending the medical emergency. This means increasing blood flow to the heart, which should also reduce the pain associated with blockage. These steps may include:

Surgery

• Angioplasty: Angioplasty is an invasive technique in which a catheter is inserted inside the blocked artery and then expanded with a balloon. A stent or mesh tube is then placed in the same location, to ensure that the vessel remains open when the catheter and balloon are withdrawn. 
• Bypass surgery: Bypass surgery involves the grafting of an unblocked segment of artery onto the heart, as an alternative passageway for blood flow. The new segment is harvested from another location in the body, typically in the arms or legs. 

Medications

• ACE inhibitors: ACE is short for angiotensin-converting enzymes. ACE inhibitors are medications that increase blood flow by expanding vessel walls. 
• Angiotensin receptor blockers: Also called ARBs, angiotensin receptor blockers counteract hypertension. 
• Antiplatelet drugs: Antiplatelet drugs decrease blood-clot formation. Aspirin is an antiplatelet drug.
• Beta blockers: Beta blockers slow down heart function, which reduces the demands it places on the circulatory system. 
• Nitroglycerin: Nitroglycerin is a traditional anti-heart attack medication. It opens blood vessels, increases blood flow, and suppresses angina (chest pain). 
• Thrombolytics: Thrombolytics dissolve blood clots. 
• Statins: Statins are an anti-cholesterol medication. Controlling bloodstream cholesterol is important because it is one of the constituent elements in plaque, along with fats and calcium. There is also evidence that statins help stabilize the plaque deposits that have already formed. 

It is possible to reduce your risk of developing an ACS condition by: 

• Adopting a heart-healthy (low fat, lean protein) diet
• Exercising and staying physically active
• Managing cholesterol, blood pressure, and glucose levels
• Losing weight, if you’re over the recommended range for your height and build
• Lowering stress by means other than alcohol consumption
• Stopping the use of all tobacco products, especially cigarettes