Acute Coronary Syndrome

Acute coronary syndrome is an umbrella term for a variety of cardiac conditions. Acute coronary syndrome treatment options depend on overall condition of the patient. Angioplasty and coronary bypass surgery are two of surgical treatment options. Below, we provide the information regarding other available acute coronary syndrome treatment options, as well as pros of having a coronary bypass surgery or stenting done in Singapore.

Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. This condition often causes severe chest pain and discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment are to improve blood flow, treat the complications and prevent future problems.

Heart attack and unstable angina are well-known acute coronary syndromes. They are umbrella terms for situations where the blood supplied to the heart muscle is suddenly blocked.

Myocardial infarction (heart attack) is when cell death results in damaged or destroyed. The reduced blood flow alters heart function and indicates a high risk of heart attack even when acute coronary syndrome causes no cell death.

Am I at risk?

Similar to heart failure and stroke, people who have certain risk factors are more likely to develop acute coronary syndromes. The factors include:

  • Smoking
  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Physical inactivity
  • Overweight or obesity
  • Family history of chest pain, heart disease or stroke

Consult your doctor to help you understand your personal risk and what you can do about it.

SYMPTOMS OF ACUTE CORONARY SYNDROME

The signs and symptoms of acute coronary syndrome normally begin abruptly. They may include the following:

  • Chest pain (angina) or discomfort (aching, pressure, tightness or burning sensation)
  • Pain( radiating from the chest to the shoulders, arms, upper abdomen, back, neck or jaw)
  • Nausea or vomiting
  • Indigestion
  • Shortness of breath (dyspnea)
  • Sudden, heavy sweating (diaphoresis)
  • Light-headedness, dizziness or fainting
  • Unusual or unexplained fatigue
  • Feeling restless or apprehensive

These signs and symptoms are not to be taken lightly. Call the doctor immediately if you experience chest pain or other symptoms. Chest pain that is triggered by acute coronary syndromes can occur suddenly (as is the case with a heart attack). Sometimes, the pain can be unpredictable or worsen even with rest (both well- known symptoms of unstable angina).

Years of cholesterol build-up in arteries in people who experience chronic chest pain can develop acute coronary syndrome if a blood clot forms on top of the plaque build-up.

ACUTE CORONARY SYNDROME TREATMENT OPTIONS

Immediate treatment goals are to:

  • Relieve pain and distress
  • Improve blood flow
  • Restore heart function as quickly and as best as possible

Long-term treatment goals are to:

  • Improve overall heart function
  • Manage risk factors
  • Lower the risk of a heart attack

A combination of drugs and surgical procedures may be used to meet these goals. They include:

Medications

Based on your diagnosis, medications for emergency care or ongoing management (in some cases both) may include:

  • Thrombolytics (clot busters): Dissolve blood clots that are blocking an artery.
  • Nitroglycerin: Temporarily improves blood circulation by widening blood vessels.
  • Antiplatelet drugs: Prevent blood clots from forming. They include aspirin, clopidogrel (Plavix) and prasugrel (Effient) ans several others.
  • Beta blockers: They work to relax your heart muscles and slow your heart rate which decreases the demand on your heart and lowers your blood pressure. They include metoprolol (Lopressor), nadolol (Corgard) and several others.
  • Angiotensin-converting enzyme (ACE) inhibitors: They expand blood vessels and improve blood flow. This allows the heart to work more easily and efficiently. These medications include lisinopril (Prinivil, Zestril), benazepril (Lotensin) and several others.
  • Angiotensin receptor blockers (ARBs): They control blood pressure. They include irbesartan (Avapro), losartan (Cozaar) and several others.
  • Statins: This helps to lower the amount of cholesterol circulating in the blood and may also stabilize plaque deposits. This will make them less likely to rupture. These medications may include atorvastatin (Lipitor), simvastatin (Zocor) and several others.

Surgery and other procedures

Your doctor may recommend one of the procedures below when medications aren’t enough to restore blood flow to your heart muscles:

  • Angioplasty and stenting: A long, tiny tube (catheter) is inserted into the blocked or narrowed part of your artery. A wire with a deflated balloon is inserted in the catheter to the narrowed area. The balloon will then be inflated which opens the artery by compressing the plaque deposits against your artery walls. A mesh tube (stent) is normally left in the artery to help keep the artery open.
  • Coronary bypass surgery: A piece of blood vessel (graft) from another part of your body is extracted. It is then used to create a new route for blood that goes around or bypasses a blocked coronary artery.

    • Acute coronary syndrome; Acute coronary syndrome treatment; Angioplasty; coronary bypass surgery

DIAGNOSING ACUTE CORONARY SYNDROME

    • History taking and physical exam: Your doctor will ask you questions about your usual life style, symptoms you are having and family history of heart diseases. Then he will perform a physical examination, which includes checking you pulse, blood pressure, auscultation and percussion of your heart.
    • Electrocardiogram (ECG): Electrodes are attached to your skin to measure electrical activity in your heart. Any abnormality or irregularity in your pulses can indicate poor heart function due to a lack of oxygen to the heart. Certain patterns in electrical signals may point toward the general location of a blockage. The test may be repeated a few times.
    • Blood tests: If cell death has resulted in damage to heart tissue, certain enzymes may be detected in the blood. Results that come back positive indicate a heart attack.

The information gathered from these two tests (ECG and blood test) as well as the signs and symptoms can provide the primary basis for a diagnosis. It can also determine whether the condition can be classified as a heart attack or unstable angina.

To characterize the condition more thoroughly, other tests may be ordered to rule out other conditions. Combined diagnostic and treatment interventions may also be used.

  • Coronary angiogram: X-ray imaging is used to see your heart’s blood vessels. A long, tiny tube (catheter) is threaded through an artery (usually in your arm or groin) to the arteries in your heart. A dye (which can be detected by X-rays) is administered through the tube to your arteries. Multiple X-ray images of your heart can show any blockage or narrowing of the arteries. The catheter may also be used during treatments.
  • Echocardiogram: Sound waves directed at your heart from a wand-like device can produce a live image of your heart. It can also help to determine whether the heart is pumping correctly.
  • Myocardial perfusion imaging (MPI): This test reveals how well blood flows through your heart muscle. A small and safe amount of radioactive substance is administered into your blood. A specialized camera will then detect the blood as it flows through your heart to reveal whether there is enough blood flowing through your heart muscles and where blood flow is reduced.
  • Computerized tomography (CT) angiogram: A specialized X-ray technology that can produce multiple cross-sectional 2-D slices of your heart. These CT scans can detect narrowed or blocked coronary arteries.
  • Stress test: This test assesses how well your heart functions when you exercise. Sometimes, you may be required to take a medication to increase your heart rate rather than exercising. This test is performed only when there is no evidence of acute coronary syndrome or another life-threatening heart condition when you are resting. Heart function may be assessed by an ECG, echocardiogram or myocardial perfusion imaging during the stress test.