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Clinical Specialties
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Acute Coronary Syndrome

DEFINITION

There are several conditions that fall under the category of Acute Coronary Syndrome: two types of heart attacks called STEMI and NSTEMI (ST-elevation myocardial infarction and non-ST elevation myocardial infarction) and unstable angina. Acute Coronary Syndrome (ACS) is essentially a condition where the heart loses its blood supply. When this happens, the heart can stop functioning properly. This is a very serious condition which can rapidly lead to death. ACS is usually diagnosed in an emergency room or in the hospital. Normally, blood is supplied to the heart muscle through arteries around the heart. As with all organs in the body, the heart requires the oxygen from blood in order to function properly. Plaques made partly of cholesterol can build in these arteries, making them smaller and less able to provide blood to the heart muscle. You may not have any symptoms from the plaques that are building in your arteries. In ACS, one of those plaques gets a small break. The body thinks this is something it needs to patch up, so it forms a small plug of platelets there (like a clot). Unfortunately, that clot can close off blood supply to the heart muscle and cause that muscle to die if blood flow is not restored. This condition can occur to people with known heart problems, but can also occur to people who do not have any known heart problems. Sometimes ACS can occur without a clot, especially in the presence of cocaine. Risk factors include older age, high blood pressure, high cholesterol, smoking, diabetes, kidney disease, and a family history of heart attacks. It is extremely important to get to the emergency room quickly because this condition can lead to death if not treated.

SYMPTOMS
Chest pain, heavy sweating, nausea, tingling or in the neck or arm, pain in the neck or arm, pain or discomfort in the chest which does not improve or happens at rest, feeling clammy, feeling lightheaded, fatigue

DIAGNOSIS
Acute coronary syndrome is diagnosed at the hospital through thorough history as well as a series of blood tests and an electrocardiogram (EKG or ECG). An EKG is done by placing small stickers over the chest which are attached to a machine to create a picture of the electrical activity of the heart. This picture can tell a cardiologist what areas may not be working properly. An EKG can help determine if you are having a heart attack and what the next step in treatment should be. Further testing can include various ways of looking at the heart muscle including echocardiograms (ultrasound of the heart), CT scans of the heart to look at the arteries, and stress tests (where the heart is induced to pump faster either by exercise or medicine while a picture of the heart’s motion is taken). A person with ACS may also need an angiogram, a procedure done by a doctor with specialized training called an interventional cardiologist. During this procedure, a thin wire is placed in one of the blood vessels in the leg or wrist and fed up to the heart. The cardiologist then injects dye through that small wire and takes pictures of the arteries of the heart. If vessels are found which are too small, the cardiologist may be able to either use small balloons to open them or place stents (tube-shaped wire meshes) which helps keep the arteries open.

TREATMENT
Treatment for ACS depends on what type of ACS you are having. Treatments can include oxygen and medicines. Medicines can include aspirin (to keep more clot from forming), beta-blockers (to slow the heart rate and decrease the heart’s demand for oxygen), nitrates (to dilate the blood vessels and allow more blood to pass), pain medications, and heparin or similar medications (to thin the blood and keep more clot from forming). Sometimes, other medications may be used depending on your unique situation. The cardiologist will likely perform some of the procedures like an angiogram with balloon angioplasty or stent placement described in the diagnosis section in order to try to replace blood flow to your heart. If you think you may be having acute coronary syndrome, you need to go to the nearest emergency room. Delaying treatment for acute coronary syndrome can be deadly.

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