Acute coronary syndrome

You are a heart patient and have often known how you get unrest and pain in the chest every time you climb a fleet of steps. You stop, take your prescribed medicines and get relief. Little do you know why this is occurring and how dangerous is the situation. Since you get the symptoms often, you would like to see a doctor.

About Acute Coronary Syndrome

Acute coronary syndrome refers to the clinical condition characterized by symptoms of a heart attack or a probability of one. These symptoms are due to reduced blood flow in the vessels that supply the heart, and are an indication of coronary artery disease.

Acute coronary syndrome is caused by blockage in one or more vessels that supply the heart. The blockage is caused by fatty deposits called plaques. These occur due to the process of atherosclerosis where chemically modified fats are deposited in the lumen along the walls of the vessels and narrow the lumen which in turn causes reduced blood flow in the vessels. Besides atherosclerosis, other less common causes of acute coronary syndrome include enlargement of the chambers of the heart, blockage of the vessels by clots, inflammation and swelling of the vessels, tearing away of walls of the vessels, and carbon monoxide poisoning and lung diseases that can lead to a deficiency of oxygen. Advanced age, increased blood pressure, increased sugar or fat in blood, smoking, and increased occupational stress can increase the risk for acute coronary syndrome.


The commonest symptom of an acute coronary syndrome is chest pain. The pain may be felt like a pressure, tightness, or sensation of burning. This typical pain is called angina pain.

Shortness of breath, feeling of vomiting, and a sudden episode of heavy cold sweating are the other coronary artery disease symptoms.

Acute coronary syndrome can have other presentations like abdominal pain, cold clammy skin, light-headedness, dizziness, restlessness, unusual fatigue, heartburn, and fainting. The symptoms differ according to age and presence of underlying medical conditions like diabetes.

  • The first test for any symptom of acute coronary syndrome is an electrocardiogram (ECG). This is a record of the electrical activity of the heart.
  • As the heart tissues are damaged due to paucity of blood supply, several protein entities called enzymes leak into the blood. The levels of these can be determined in the blood to estimate the extent of damage to the heart muscle.
  • Once the symptoms have settled, tests may be done to find the state of blood flow to the heart. This is most reliably done with a coronary angiography or cardiac catheterization. A dye or contrast is injected into the circulation and pictures are taken to view the blood supply to the heart.
  • An echocardiogram is a test done to obtain pictures of the heart that helps to find the pumping ability.
  • A chest X-ray allows checking the size and shape of the heart and the big vessels.
  • A nuclear scan uses radioactive material to delineate areas of reduced blood flow in the heart.
  • Computerized tomography (CT) angiogram is another test that shows the narrowed vessels.

Acute coronary disease treatment depends upon the severity of symptoms and extent of blockage.

  • In an emergency, oxygen and pain relief using medicines like morphine or nitroglycerin may be needed.
  • Thrombolytic medicines like alteplase, reteplase, or tenecteplase may be infused to break down the blockage and restore the blood flow to the heart.
  • Medicines to control abnormal heart rhythms may be needed if there is an abnormality in one.
  • Other medicines that may be used include those:
    • To prevent further blockage like aspirin and clopidrogel
    • To relax the vessels to increase blood flow to the heart such as nitroglycerin
    • To help the heart to work better by improving the dynamics of blood flow to the heart like beta blockers, calcium channel blockers, or angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)
    • To lower the blood cholesterol and harmful lipids like statins
  • If the medicines do not provide ample relief, surgical procedures maybe done to restore the blood flow to the heart.
    • One such procedure is angioplasty and stenting. In this, a wire is threaded through a vessel in the arm or leg up to the heart and then the blockage is located and opened up by inflating a balloon locally in the blocked area. This may be done through a laser technique as well.
    • In another procedure call coronary artery bypass grafting (CABG), alternative vessels are grafted to bypass the blockages. This is done opening the rib cage and directly operating upon the heart.

Acute coronary syndrome can be prevented by changing lifestyle, taking proper medication, and observing precautions.

  • Diet should be controlled and exercise should be a part of daily routine to prevent weight gain which is a risk factor for acute coronary syndrome. Exercise of at least 30 to 60 minutes should be done at least 5 days in a week.
  • Fresh fruits, vegetables, low fat dairy products, and water should be included in dietary planning.
  • Blood pressure, blood sugar, and cholesterol should be kept in control by regular medication.
  • Blood thinning agents like aspirin or clopidogrel may help to make the blood less viscous and easy flowing.
  • Smoking is an independent risk factor for coronary heart disease and should be quit completely.

Acute Coronary Syndrome should never be ignored as being trivial even if the symptoms are not severe. Regular treatment is a must to prevent any further episodes. Diet control, lifestyle changes, and exercise have immense benefits.