Acute Coronary Syndrome – Pathophysiology, Symptoms & Treatment

What is Acute Coronary Syndrome?

Acute coronary syndrome is a medical condition that causes rapid and diminished blood circulation toward the heart. Acute coronary syndrome is characterized by a chest pain you might experience while having a heart attack, or chest pain you might experience while you are resting or doing an easy work. Acute coronary syndrome is typically confirmed inside an emergency room or hospital.

Acute coronary syndrome is manageable if confirmed immediately. Acute coronary syndrome managements differ, based on your manifestations and general health status.

Pathophysiology

Generally the syndrome happen when plaques inside a narrowed blood vessel comes apart, splits, or ulcerate and cause development of thrombus. This will lead in unexpected full or partial blockage of the arteries. Also, the thrombus may dislodge from a broken plaque and block the blood vessels.

Systemic issues and swelling can also add to changes in hemostatic and coagulation paths and might take part in the beginning of the irregular thrombosis that is a main sign of unstable angina. Inflammatory acute stage proteins, cytokines, long-time infections and catecholamine rushes may improve the manufacturing of tissue factor, pro-coagulant movement or thrombocyte hyperaggregability.

In unusual cases it may be brought about by coronary artery occlusion by emboli, congenital defects, spasm of the heart and an extensive array of systemic problems. At first, the infarcted muscle is tone down that will result in an elevation in the compliance of the ventricles, however, as scarring happens, compliance reduces.

Causes & Risk Factors

Acute coronary syndrome may happen gradually in the long run by the formation of plaques inside your heart arteries. These plaques, consisting of fatty plaques, cause arterial stenosis and make it harder for blood to pass through. This plaque formation is called as atherosclerosis. Ultimately, this plaque formation signifies that your heart can’t pump adequate oxygenated blood to the entire body, leading to chest pain or a heart attack.

If one of the plaques inside your heart blood vessels dislodged, it might lead to a heart attack. Actually, many cases of coronary artery syndrome happen following dislodge of a plaque. Blood coagulation will develop on the area where it dislodged, obstructing the blood circulation to that artery.

The risk factors of acute coronary syndrome involve the following:

1. Aging
2. Elevated blood pressure
3. Elevated blood cholesterol
4. Cigarette smoking
5. Sedentary lifestyle
6. Type 2 diabetes
7. Family history of chest pain, heart disease or stroke

Symptoms & Signs

Knowing te signs and symptoms of acute coronary syndrome might save your life. If left untreated acute coronary syndrome can lead to a heart attack. When you experience any of the following symptoms it is important that you will take it seriously and will seek medical help immediately. It is also important to ask for someone to bring you to the hospital and not drive on your own.

1. Chest pain characterize by burning feeling, heaviness or tightness and persists for more than a few minutes or longer
2. Pain somewhere else in the body, like the left upper arm or jaw, this could be a referred pain
3. Nausea and vomiting
4. Difficulty of breathing
5. Sudden and heavy sweating

Other unusual symptoms are the following:

1. Pain the abdominal area
2. Pain akin to a heartburn
3. Moist skin
4. Dizziness or fainting
5. Unusual exhaustion
6. Restlessness or nervousness

Pictures

Acute Coronary Syndrome Pictures

Diagnosis Guidelines

If you experience manifestations of acute coronary syndrome, your physician will now subject you to different diagnostic test to confirm a heart attack or an angina.

Electrocardiogram (ECG)

This is the initial test performed to confirm a heart attack. It’s frequently performed while you are being interviewed about your symptoms. This examination takes note of the electrical movement of your heart by means of electrodes stick to your skin. Impulses are noted as “waves” shown on a screen or printed on paper. Since damaged heart muscle doesn’t conduct electrical impulses usually, the ECG may display that a heart attack has happened or is happening.

Blood tests

Specific heart enzymes gradually seep out into your blood if your heart has been injured by a heart attack. Emergency room personnel will take your blood to confirm for the presence of these enzymes.

Your physician will look at these examination results and decide the severity of your problem. If your blood analysis shows negative markers of a heart attack and your chest pain has diminished, you will probably be having tests to confirm the blood circulation through your heart.

Echocardiogram

If your physician decides you haven’t had a heart attack and your chance of experiencing a heart attack is low, you will probably have an echocardiogram done prior to leaving the hospital. This diagnostic test makes use of sound waves to create a picture of your heart. An echocardiogram can help confirm whether an area of your heart has been injured by a heart attack and isn’t working properly.

Chest X-ray

An X-ray picture of your chest lets your physician to verify the size and shape of your heart and its blood vessels.

Computerized tomography (CT) angiogram

A CT angiogram let your physician to make sure your arteries are not narrowed or obstructed. This test is typically only performed if your blood examinations and electrocardiogram don’t show the origin of your symptoms.

Coronary angiogram (cardiac catheterization)

This examination can explain if your coronary arteries are narrowed or obstructed. A liquid dye is placed into your heart arteries with a catheter that will pass inside an artery, frequently in your leg, toward the arteries of your heart. As the dye filled the arteries, the arteries will now be observable on X-ray, showing sites of occlusion. In addition, while the catheter is inside the artery, your physician may manage the blockage by doing an angioplasty. Angioplasty makes use of small balloons threaded inside a blood vessel and into a coronary artery to broaden the occluded area. In usual cases, a stent (medical tube) is also positioned inside the artery to hold it wide open more extensively and avoid narrowing again in the future.

Treatment

Treatment for acute coronary syndrome differs based on your symptoms and how obstructed your arteries are.

A) Medications

It’s possible that your physician will prescribe drugs that can ease chest pain and enhance blood circulation to the heart. These are the following medications that can be prescribed for you:

1. Aspirin

Indicated to decrease blood coagulation

Keep blood circulation inside the narrowed heart arteries

2. Thrombolytics

Also known as clot busters

Indicated to help dissolve a blood clot that is obstructing the blood circulation to your heart

The earlier you take a thrombolytic medication following a heart attack, the better the likelihood you will stay alive and decrease the injury to your heart

3. Nitroglycerin

Momentarily broadens narrowed arteries, enhancing blood circulation to and from your heart.

4. Beta blockers

Indicated to relax your heart muscle, slow your heart beat and lower your blood pressure, which lessens the demand on your heart

It can increase blood circulation through your heart, relieving chest pain and the risk for injury to your heart

5. Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin receptor blockers (ARBs).

They let blood to flow from your heart more simply

They decrease blood pressure and may stop a second heart attack

6. Calcium channel blockers

Indicated to relax the heart and allow more blood to flow to and from the heart

7. Cholesterol-lowering drugs

Indicated to decrease your cholesterol levels, leading to less plaque deposits

8. Clopidogrel

Indicated to help avoid blood clots from developing

May cause bleeding

B) Surgery and other procedures

Is symptoms persist, despite medications, the physician may suggest these surgeries as a last resort:

a) Angioplasty and stenting

In this surgical procedure, your physician will place a catheter into the obstructed or narrowed area of your blood vessel. A wire with a deflated balloon is entered through the catheter to the area of stenosis. The balloon is then inflated, constricting the plaques against the lining of your artery. A stent (medical tube) is typically left behind in the artery to hold the artery wide open. Angioplasty may also be performed using laser technology.

b) Coronary bypass surgery

This surgical procedure develops a substitute path for blood to go around an obstructed coronary artery.