Acute Coronary Syndrome
Understanding ACS
Acute Coronary Syndrome
What is ACS?
Acute Coronary Syndrome occurs when there is a sudden decrease in blood flow to the heart. This is a result of a blockage in the coronary arteries.
STEMI vs NSTEMI
The type of heart attack (also called myocardial infarction or MI) will affect the treatment that your medical team suggests
- STEMI: Defined by specific EKG changes (ST elevations), indicates complete blockage of a coronary artery
- NSTEMI: ST elevations are not seen on EKG, indicates partial blockage of a coronary artery
Unstable Angina
- Characterized by sudden chest pain that often occurs at rest.
- Usually due to a ruptured or unstable atherosclerotic plaque which can cause a blood clot leading to partial blockage of a coronary artery
- Requires urgent evaluation and treatment to prevent a heart attack
Causes and Risk Factors
- Smoking
- High Blood Pressure
- High Cholesterol
- Diabetes
- Obesity
- Family History of Cardiovascular Diseases
Common Symptoms
- Chest Pain or Pressure
- Pain or discomfort radiating to neck, jaw, shoulders, arm, back
- Lightheadedness or dizziness
- Nausea or symptoms that may feel like indigestion/heartburn
- Shortness of breath
- Sweating (diaphoresis)
Diagnosis and Treatment
How is ACS diagnosed?
- ACS is an umbrella term that refers to heart attacks (myocardial infarctions) or unstable angina
- Initial work up includes blood work such as cardiac enzymes (troponin levels) and an ECG/EKG
- If initial work up is concerning for ACS, a cardiac catheterization (angiogram) is typically done to visualize the coronary arteries (using dye) and assess the degree of blockage.
Treatment Overview
- Depending on the results of the angiogram and the treatment options available at the hospital, there are several different treatment pathways: medical management, fibrinolytic therapy, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
- Medications
- Fibrinolytic Therapy
- Percutaneous Coronary Intervention (PCI)
- Coronary Artery Bypass Grafting (CABG)
Medical Management of ACS
- Dual Anti-platelet Therapy: prevents formation of blood clots by preventing platelets from sticking together. Typically aspirin and another agent such as clopidogrel (Plavix), ticagrelor (Brilinta), or prasugrel (Effient) are used.
- Anticoagulation: thins the blood, breaking down clots or preventing new clots from forming. Examples: IV or injectable heparin (i.e. enoxaparin/lovenox).
- Nitroglycerin: works to relieve chest pain by relaxing blood vessels
- Morphine: used for chest pain that does not respond to nitroglycerin
- Medications to lower cholesterol (i.e. statins)
- Beta Blockers: lower heart rate, relax heart and blood vessels, lower blood pressure
- ACE inhibitors/ARBs: relax blood vessels and lower blood pressure
Fibrinolytic Therapy, PCI, CABG
- Fibrinolytic Therapy: medications are administered to break up clots (IV or catheter directed)
- PCI: minimally invasive procedure, opens a blocked coronary artery (typically using a stent, which usually releases a medication that helps to keep the artery open)
- CABG: open heart surgery, creates a bypass around a blocked coronary artery, multiple bypasses may be needed if several arteries are blocked
What to Expect During Your Hospital Stay
- EKGs and bloodwork
- Telemetry monitoring (24/7 monitoring of your heart rhythm)
- Cardiology evaluation and discussion of the above interventions (medical management vs. procedures)
Recovery and Outlook
Lifestyle Changes
- Dietary Modifications
- Cardiac Rehab