Acute Coronary Syndrome – Diagnosis and Treatment
Acute coronary syndrome (ACS) is a group of conditions caused by sudden, reduced blood flow to the heart. This important medical problem often links to a blockage in the arteries that supply the heart.
Plaque buildup in the blood vessels, a process called atherosclerosis, usually causes these blockages. High cholesterol levels, high blood pressure, and diabetes are common risk factors that worsen this buildup, increasing the risk for ACS.
A family history of heart disease can also raise a person’s risk.
Symptoms of ACS may include chest pain or discomfort, shortness of breath, and feeling unusually tired or weak. People with coronary artery disease or atherosclerotic cardiovascular disease should be alert to these signs.
Diagnnosis
Heart and Blood Tests
Doctors often begin diagnosing acute coronary syndrome by asking about chest pain, shortness of breath, and other symptoms.
They use a combination of tests to confirm if someone is experiencing a heart attack, an unstable angina event, or another heart-related emergency.
The electrocardiogram (ECG or EKG) is usually the first test doctors order. They place small sensors called electrodes on the chest, and sometimes on the arms and legs, to check the heart’s electrical activity.
Changes in the pattern—such as ST elevation or other differences—can signal a myocardial infarction (MI), including STEMI (ST-elevation myocardial infarction) or NSTEMI (non-ST-elevation myocardial infarction).
This test is quick and gives important clues about whether the heart is getting enough blood. Blood tests play another important role in the diagnosis. When the heart muscle gets damaged, special proteins like troponin leak into the bloodstream.
High-sensitivity troponin assays help doctors determine if a heart attack, also called acute myocardial infarction, has happened. Elevated levels of troponin suggest injury to the heart muscle and help separate MI from unstable angina, which does not show these changes.
Imaging and Specialized Procedures
Doctors may use several imaging tests to see how well the heart is working and to find any blocked arteries.
The echocardiogram uses sound waves to make moving images of the heart. It shows how blood moves through the heart and its valves, and can detect problems with pumping.
If the heart is not pumping normally, this may signal damage from a heart attack. Doctors perform a coronary angiogram to find blockages in the coronary arteries.
They insert a thin tube (catheter) into a blood vessel in the wrist or groin and guide it to the heart. Doctors release a special dye and take X-ray images as the dye goes through the arteries.
This test shows where blockages are and how severe they are. Treatments like angioplasty can even begin during this test if needed.
The CT angiogram is a non-invasive test that uses a strong X-ray machine to get pictures of the arteries that supply blood to the heart. This helps doctors detect narrowing or plaque buildup in the coronary arteries.
Myocardial perfusion imaging involves injecting a small amount of safe radioactive material into a vein.
A special camera takes pictures as the substance moves through the heart muscle, letting the doctor see areas where blood flow might be reduced or blocked.
Exercise and Stress Testing
An exercise stress test checks how the heart works during physical activity, usually on a treadmill or stationary bike.
During the test, doctors monitor the heart for any signs of trouble. If the person cannot exercise, doctors may use medicine to make the heart work harder instead.
This type of test is only used if there are no clear signs of a heart attack or dangerous symptoms at rest.
| Test Name | What It Checks | Helps Diagnose |
|---|---|---|
| Electrocardiogram (ECG/EKG) | Heart’s electrical activity | STEMI, NSTEMI, MI |
| Blood tests (Troponin) | Heart muscle injury | Heart attack, MI |
| Echocardiogram | Heart function, pumping | Heart damage |
| Coronary Angiogram | Blocked arteries | STEMI, NSTEMI, unstable angina |
| CT Angiogram | Plaque in arteries | Atherosclerosis, MI risk |
| Myocardial Perfusion Imaging | Blood flow in heart muscle | Areas of poor flow, damage |
| Exercise Stress Test | Heart function during activity | Ischemia, angina |
Doctors use these tests together to decide if someone has a heart attack, unstable angina, or another cause for their symptoms. They examine both test results and symptoms to make the diagnosis and plan treatment.
Treatment
Medication Approaches
Doctors start with medications to manage acute coronary syndrome. These drugs help relieve pain, improve blood flow, and lower the risk of future heart problems. Some important groups of drugs are listed in the table below:
| Medication Type | Purpose |
|---|---|
| Clot-dissolvers | Break up artery blockages |
| Vessel expanders | Open up blood vessels |
| Blood thinners | Prevent new clots |
| Heart slowdown agents | Lower heart workload and blood pressure |
| Angiotensin-converting enzyme (ACE) inhibitors | Improve blood flow by relaxing blood vessels |
| Angiotensin II receptor blockers (ARBs) | Control blood pressure |
| Cholesterol-lowering | Reduce plaque in arteries |
Antiplatelet drugs like aspirin help prevent blood from clotting inside arteries. Doctors often give these along with other blood thinners. Thrombolytic drugs, also called clot busters, play a key role if an artery is blocked and must be cleared quickly.
Many patients take beta blockers to slow the heartbeat and reduce the heart’s need for oxygen. ACE inhibitors and ARBs both help lower blood pressure and can improve heart function after an event.
Doctors prescribe statins to manage cholesterol, helping lower the chance that new fatty plaques form inside heart arteries. For some people, other cholesterol medicines like ezetimibe may also be used.
Procedures and Surgical Care
If medicines alone do not work, or when there is a high risk of heart damage, heart specialists may choose surgical and other procedures. Some of the main options include:
Opening Blocked Arteries (Angioplasty and Stenting): Specialists insert a thin tube through a blood vessel in the arm or groin and guide it to the heart. They inflate a small balloon at the tip to open the blockage. Often, they leave a mesh tube called a stent in place to keep the artery open. This is also known as percutaneous coronary intervention (PCI).
Bypass Surgery (Coronary Artery Bypass Graft or CABG): A surgeon removes a healthy blood vessel from another area of the body. The surgeon attaches this vessel to the heart to allow blood to detour around the blocked area.
Cardiac Catheterization: Doctors use this procedure to examine the condition of heart arteries, see which arteries are narrowed or blocked, and decide the best treatment.
Fibrinolytic Therapy: Doctors may give this treatment when angioplasty cannot be done right away. The goal is to quickly break down clots and restore blood flow.
Managing Complications: If heart failure or cardiogenic shock develops, doctors may give special medicines (such as inotropes) or use supportive devices to help the heart pump.
Specialists consider each patient’s situation to pick the best treatment path. They weigh the risks and benefits of each option. Treatments are tailored to control symptoms, restore heart function, and lower the risk of future problems.
Everyday Habits and Home Steps
Making healthy choices every day can support the heart and lower the risk of new or worsening heart problems. Here are some changes and actions that can help:
Healthy Habits Table
| Habit | Details |
|---|---|
| Avoid Tobacco | Stop smoking and do not use tobacco products. Stay away from places with secondhand smoke. |
| Balanced Diet | Eat more fruits, vegetables, and whole grains. Cut down on salt, sugar, and fatty foods. |
| Stay Active | Try for at least 30 minutes of moderate or strong physical activity, 5+ days a week. |
| Sleep Well | Aim for 7–9 hours of sleep each night. Use a regular bedtime and morning routine. |
| Healthy Weight | Work to keep a healthy body weight. Ask for advice if you want help setting goals. |
| Manage Stress | Try exercise, mindfulness, or talking with others to handle stress. |
| Limit Alcohol | If drinking, stick to one drink per day for women and two for men. |
Exercise and Activity
Regular exercise supports both primary and secondary prevention of heart problems. Even walking, biking, or using a treadmill can help.
For those needing extra support, doctors may suggest cardiac rehab. This special program helps people recover after heart events and teaches safe ways to be more active.
Regular Health Checks
A healthcare team should check blood pressure and cholesterol often. High cholesterol or high blood pressure can harm the heart. Staying in touch with professionals helps track progress and update care plans.
Making Changes at Home
Small changes, like eating healthier snacks, avoiding tobacco, or setting a regular sleep schedule, can make a difference. Support from family or support groups can help with goals.
Getting Ready for Your Visit
Preparing for a medical appointment when experiencing signs of acute coronary syndrome is important for both safety and clear communication.
Gathering the right information helps healthcare workers make quick and accurate decisions. It can also make the appointment more useful and less stressful.
Key Information to Have Ready
Before the visit, write down a list of your current symptoms. Note when they began, how long they lasted, and if they come and go or are constant.
Being able to answer these questions makes it easier for the medical team to understand what is happening.
Details to Share
- When Symptoms Started: Knowing the exact time or date helps doctors see how urgent the situation is.
- How Long Symptoms Lasted: This detail can point to how serious the episode might be.
- What Symptoms are Present: Chest pain, shortness of breath, or feeling weak should all be mentioned.
- Description of Pain: Is the pain sharp, dull, squeezing, or burning?
- Location of Pain: Note if the pain stays in one place or moves to the arms, jaw, or back.
- Pain Level: Rate your pain from 1 (mild) to 10 (extreme).
- What Makes It Better or Worse: Share if anything reduces or increases your symptoms, such as rest or activity.
Sample Table for Tracking Symptoms
| Symptom | Start Date & Time | Duration | Pain Level (1-10) | What Helps | What Makes Worse |
|---|---|---|---|---|---|
| Chest Discomfort | May 20, 2:00 pm | 10 min | 7 | Rest | Walking |
| Shortness of Breath | May 20, 2:05 pm | 10 min | 6 | Sitting | Climbing stairs |
Personal Medical Information to Bring
- List of current medications, including any heart-related drugs.
- All known allergies, especially to medicines.
- A summary of your medical history, including any past heart issues.
- Contact information for your doctors.
- Family history of heart disease, if known.
Questions to Consider Asking
- What tests will be needed to confirm the diagnosis?
- What are the treatment options?
- How soon do results become available?
Other Helpful Tips
- Bring a trusted friend or family member for support.
- Keep a notebook for questions and notes.
- If symptoms are severe or sudden, such as chest pain or fainting, call emergency services instead of waiting for an appointment.
What Not to Forget
Bring a form of ID, your insurance card, and any important medical records. Being prepared can help the visit go smoothly. Patients can feel more in control by being able to answer important questions and by having their information organized and ready to share.
