Generality
Acute coronary syndrome is the set of symptoms and signs that arise from a narrowing, more or less severe, of the coronary arteries. In most cases, atherosclerosis is the origin of this narrowing.
Usually, the first diagnostic tests consist of an electrocardiogram and blood tests; if time permits, further investigations are carried out.
The invasiveness of the treatment (only pharmacological or even cardiac surgery) depends on the extent of the narrowing and the severity of the symptoms.
What is acute coronary syndrome?
Acute coronary syndrome is the term doctors use to refer to any heart pain due to a narrowing of the coronary arteries.
Coronary arteries, or more simply coronary, are the blood vessels that carry oxygenated blood to the myocardium, that is, the muscle tissue of the heart. Their severe occlusion can severely reduce the blood supply in a given area of the heart (ischemia) and, in severe cases, lead to the death of the affected tissue (heart attack).
ACUTE CORONARY SYNDROME, HEART ATTACK AND UNSTABLE ANGINA
Acute coronary syndrome can be the result of a heart attack or an episode of unstable angina. To establish its "exact nature is only a" careful diagnostic investigation.
- Heart attack (or myocardial infarction) is a very serious morbid condition, characterized by a closure of the coronary arteries so important that part of the myocardium undergoes necrosis (ie dies).
The death of cardiac muscle tissue is definitive (N.B: it is replaced by scar tissue) and involves the stable reduction of cardiac function. A heart that does not work as it should affect blood circulation to various parts of the body.
Clinically, acute coronary syndrome can present as a myocardial infarction following a "total occlusion of a coronary vessel or as a myocardial infarction following a" partial occlusion of the coronary arteries. - Unstable angina is a less serious pathological condition than heart attack, but still linked in some way to a narrowing of the coronary arteries.
In unstable angina, the occlusion is not such as to cause myocardial death; however, in the absence of adequate treatment, the necrosis process could occur within a short time.
The term unstable indicates that angina appears suddenly and also at rest (N.B: stable angina, on the other hand, arises less suddenly and never at rest, only under exertion).
EPIDEMIOLOGY
Acute coronary syndrome is a fairly common condition.
For example, in the UK, it appears to be responsible for around 114,000 hospital admissions per year.
The people most affected are those over the age of 50, although it should be specified that the aforementioned heart disease can also arise in young adults.
The sex more interested is the male.
Causes
The main cause of acute coronary syndrome and the coronary occlusion that distinguishes it is atherosclerosis.
Atherosclerosis is a degenerative disease of the arteries of medium and large caliber, which favors the deposit of fat and other substances on the internal vessel wall.
Figure: Atherosclerosis is the main cause of acute coronary syndrome. Among the factors that favor atherosclerosis, there is a wrong diet, containing a lot of fat.
This deposit - called atheroma or atherosclerotic plaque - obstructs blood flow and, if it breaks, gives rise to an inflammatory reaction that results in an increase in its size and a worsening of the previous picture.
Atherosclerosis, therefore, is a progressive morbid condition, which could remain silent for years, only to have serious consequences.
OTHER CAUSES
The process of occlusion of the coronary arteries, which then induces the acute coronary syndrome, can arise for reasons other than atherosclerosis.
In fact, it can be equally decisive:
- The presence of an "inflammation at the level of the coronary arteries (coronary vasculitis). This is a rather rare phenomenon.
- An episode of coronary embolism, following the disintegration of a blood clot formed in a vessel other than the coronary arteries. In other words, a part of it can detach from a thrombus located in a blood vessel or in a heart cavity and be transported by the blood to the coronary arteries.
- The intake of cocaine.
- Having undergone cardiac surgery. Heart surgery presents a fair margin of risk and acute coronary syndrome is one of the possible dangers of this practice.
- The presence of some rare heart diseases.
Factors that induce atherosclerosis:
- Old age
- Male sex
- Genetic predisposition to the disorder
- Cigarette smoke
- Hypercholesterolemia
- Hypertension
- Obesity
- Sedentary lifestyle
- Diabetes mellitus
Sometimes, atherosclerosis and the aforementioned causes work together.
RISK FACTORS
The risk factors of acute coronary syndrome, that is, all those situations that predispose to the onset of the aforementioned heart disorder, are the same as those for myocardial infarction and cardiovascular diseases in general.
They can be divided into two categories: non-modifiable favoring factors and modifiable favoring factors.
Among the non-editable, we mention:
- The advanced age
- The male sex
- Family predisposition to heart disease
- Belonging to ethnic groups particularly predisposed to cardiovascular disorders, such as the Caribbean population or the African American population.
Among the modifiable factors, however, deserve a mention:
- Hypertension
- Obesity
- Hypercholesterolemia
- The sedentary lifestyle
- An incorrect diet
- Diabetes mellitus
Symptoms and Complications
The typical symptoms and signs of acute coronary syndrome are, of course, the same as those that characterize heart attack and unstable angina, therefore: chest pain, fainting, sweating, dyspnoea (even when resting), nausea and vomiting.
THE PAIN IN THE CHEST
Figure: Chest pain is the most characteristic symptom of acute coronary syndrome
Chest pain is probably the most felt ailment and with which many medical treatises identify acute coronary syndrome.
Patients describe it as a sense of pressure in the chest, which sometimes also radiates to the jaw and left arm. This particular distribution of pain is due to an intersection of several sensitive nerve pathways.
OTHER SYMPTOMS
Sometimes, the symptomatological picture can be completed with the appearance of:
- Abdominal pain
- Stomach ache
- Cyanosis
- Syncope
- Strong sense of fatigue
- Sense of anxiety and restlessness
WHEN TO SEE THE DOCTOR?
It is advisable to contact your doctor or go to the hospital if you experience the symptoms just mentioned. In particular, attention should be paid to chest pain associated with dyspnea at rest.
The timeliness of help and the immediate start of treatment are essential to avoid the worst, including the death of the patient from heart attack.
Diagnosis
When an individual comes to the hospital with all the typical symptoms of a heart attack or unstable angina, doctors immediately submit them to an electrocardiogram (ECG).
By recording the electrical activity of the heart, the electrocardiogram allows you to determine whether the heart is beating normally or not.
During acute coronary syndrome, the heart rhythm (hence the electrical activity of the heart) is altered in an easily recognizable way.
HEART ATTACK OR UNSTABLE ANGINA?
To quickly understand whether the nature of acute coronary syndrome is linked to a heart attack or unstable angina, doctors take a blood sample from the patient.
If the analysis of this sample shows a strong presence of certain enzymes (troponins, CK-MB, etc.), it could mean that a heart attack is in progress. Conversely, if from the blood tests the presence of the same enzymes is scarce or zero, it could mean that an "unstable angina is in progress."
All this is explained by the fact that, when there is a deep damage to the myocardium, the latter releases the aforementioned enzymes into the blood.
OTHER DIAGNOSTIC PROCEDURES
When the situation is under control, for the purpose of further investigation, the doctors submit the patient to further tests and diagnostic tests.
In particular, they resort to:
- An echocardiogram
- A chest x-ray
- A CT scan
- A "coronary angiography
- An exercise test
Treatment
The therapy that is adopted in the presence of acute coronary syndrome depends on two factors: the severity of the coronary narrowing (therefore the severity of the causes) and the severity of the symptomatological picture.
For less severe cases, drug-based treatment may be sufficient; for the most severe cases, however, it is also essential to resort to cardiac surgery.
PHARMACOLOGICAL THERAPY
The medicines usually used are:- Aspirin and other blood thinners (anticoagulants)
- Thrombolytics
- Nitroglycerin
- Beta blockers
- ACE inhibitors and angiotensin receptor antagonists
- Calcium channel blockers
- Hypocholesterolemics
HEART SURGERY THERAPY
Cardiac surgery is reserved for cases with a "severe coronary occlusion, which must be released at all costs if the patient is to be saved.
The most important and practiced procedures are:
- The angioplasty followed by the stenting. During this operation, the cardiac surgeon re-establishes the original patency of the occluded coronary artery, shaping the lumen of the artery also thanks to the insertion of a hollow metal cylinder (stent).
- Coronary artery bypass grafting. Through this procedure, the heart surgeon creates an alternative route to the passage of blood, inserting a new coronary vessel.
OTHER IMPORTANT COUNTERMEASURES AND REMEDIES
In addition to the treatments described above, anyone who is a victim of acute coronary syndrome (or "other heart disease) should:
- Quit smoking (if you are a smoker)
- Adopt a healthy diet under all circumstances
- Stay active (compatibly with the health of your heart)
- Periodically check your cholesterol levels and keep them within normal values
- Check your blood pressure periodically and keep it at normal levels
- Losing weight (if you are obese or overweight)
- Learn to control the stress of everyday life
- Don't drink alcohol
- Continue to take the medications prescribed by your doctor as necessary to reduce the risk of a relapse.The medicines in question are generally aspirin, beta-blockers, ACE inhibitors and cholesterol-lowering agents.
Prognosis
Partial coronary artery occlusion and / or timely and appropriate treatment positively affect the chances of recovery. Conversely, severe coronary artery narrowing and / or delayed or inadequate therapy increase the likelihood of complications.
Therefore, the prognosis of acute coronary syndrome depends on the severity of the triggering causes and the timeliness of treatments.
