Acute Coronary Syndrome

Smoking

• Smoking damages the walls of your arteries and promotes the buildup of plaque, narrowing the vessels that supply blood to your heart.
• Even light or occasional smoking significantly raises your risk of ACS.

High Blood Pressure

• When blood pressure is consistently elevated, it puts extra strain on your artery walls, causing them to thicken and stiffen over time.
• This makes it easier for blockages to form in the coronary arteries.

Obesity

• Excess body weight — especially around the abdomen — raises blood pressure, cholesterol, and blood sugar, all of which stress the cardiovascular system.
• Obesity also promotes chronic inflammation that can destabilize arterial plaques.

Family History of Cardiovascular Diseases

• If a close relative had a heart attack or coronary artery disease at an early age, you may have inherited genes that affect cholesterol metabolism, blood pressure, or inflammation.
• This makes regular screening and lifestyle management especially important.

Chest Pain or Pressure

• Often described as a squeezing, crushing, or heavy sensation in the center or left side of the chest.
• This is the most recognized symptom of ACS and should always be treated as a medical emergency.

Pain or Discomfort Radiating to Neck, Jaw, Shoulders, Arm, or Back

• The heart shares nerve pathways with other parts of the upper body, which is why pain can appear far from the chest.
• Radiation down the left arm is particularly common, but any unexplained upper-body pain alongside other symptoms warrants immediate attention.

Shortness of Breath

• When the heart is not pumping efficiently, fluid can back up into the lungs, making it hard to breathe. This may occur with or without any chest pain.

Sweating (Diaphoresis)

• A sudden cold sweat — often described as breaking out in a sweat for no clear reason — is the body's stress response to reduced cardiac output.
• It is a particularly significant warning sign when it appears alongside other symptoms on this list.

• 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.

• 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

EKGs and Bloodwork

• An EKG (electrocardiogram) records the electrical activity of your heart and helps your medical team identify the type and location of any blockage.
• Bloodwork, particularly troponin levels, detects proteins released when heart muscle is damaged and is trended over several hours to track how your heart is responding.

Cardiology Evaluation

• A cardiologist will review your EKG results, bloodwork, and overall condition to determine the best course of treatment for you.
• This conversation will cover whether your situation can be managed with medications alone, or whether a procedure such as cardiac catheterization, stenting, or bypass surgery is recommended.