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What is Acute Coronary Syndrome?

What is Acute Coronary Syndrome?

Acute coronary syndrome is a set of diseases that affect the heart and are characterized as occurring as a result of insufficient supply of blood flow to the heart muscle (myocardial ischemia). Acute coronary syndrome can manifest as myocardial infarction or as unstable angina pectoris, depending on the degree of narrowing of the arteries that supply the heart (coronary arteries) or whether there is complete obstruction.

Acute coronary syndrome is one of the most frequent diseases in the first world and one of the main causes of mortality.

How is it produced?

The heart is nourished by a series of arteries called coronary arteries that irrigate the heart muscle and allow it to exercise its heart pump function, contracting and relaxing. Coronary atherosclerosis is a slow-growing disease in which there is progressive narrowing of the walls of the arteries due to an accumulation of lipids (fats) and inflammatory cells (lymphocytes) forming plaques.

Acute coronary syndrome is caused by the erosion or rupture of one of these plaques leading to the formation of a thrombus, thus causing the onset of unstable angina or acute myocardial infarction. Depending on the degree of occlusion of the artery it will manifest as unstable angina or myocardial infarction.

Angina occurs when the obstruction is incomplete, there is a decrease in blood supply which is known as ischemia and thus the coronary arteries cannot cover the cardiac demands of oxygen.

In myocardial infarction, a complete occlusion of the artery occurs due to a clot that causes necrosis or death of cardiac tissue in the area irrigated by the vessel.

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There are a number of risk factors that favor the occurrence of acute coronary syndrome. These factors include: sex (more frequent in males), age (from 70 years), tobacco, diabetes, elevated, cholesterol, overweight, family history of coronary disease, hypertension and sedentary lifestyle. It is important to know them because preventive measures are the main weapon of treatment to avoid this disease.

In some cases acute coronary syndrome may be the result of increased heart oxygen requirements in the absence of a thrombus. This can occur in: arrhythmias, trauma, drug and drug use, infections, or coronary artery anomalies.

Symptoms

The key symptom in acute coronary syndrome is the occurrence of pain in the center of the chest and / or the left arm. The duration of this pain is usually minutes in the case of angina and more prolonged in myocardial infarction. Other symptoms such as nausea and malaise, pain in the pit of the stomach, feeling of shortness of breath, sweating and dizziness may occur. Patients may have hypotension or hypertension and arrhythmias and heart failure appear.

Acute Coronary Syndrome

Diagnosis

The diagnosis is based primarily on the patient’s symptoms and a series of tests to help confirm it.

  • Performing an electrocardiogram is imperative in all patients who come with symptoms suggestive of acute coronary syndrome. The electrocardiographic record allows to know the degree of injury of the heart.
  • Determination of markers of myocardial damage: cardiac enzymes. They are a series of substances that are eliminated to the blood when there is injury of the cardiac muscle (myocardium). They are measured with a blood test at regular intervals from the onset of symptoms and their elevation in the following hours allows the diagnosis of myocardial infarction to be established.
  • Chest x-ray to see if there is fluid in the lungs resulting from failure of heart function
  • Echocardiogram and isotopic ventriculography. They allow to assess the function of the heart and if there are areas that due to myocardial injury are not contracted correctly.
  • The exercise test or ergometry is the most used test to assess the presence of ischemia of the cardiac muscle. It allows to know if the chest pain is due to the obstruction of a coronary artery, especially in those patients who present a normal electrocardiogram. It consists in subjecting the patient to physical exercise on a treadmill or on a bicycle and to detect if the exertion causes ischemia. This is detected by the appearance of symptoms and alterations of the electrocardiogram.
  • Coronary arteriography also called coronary angiography or catheterization is a test that is performed primarily in patients with major ischemia or when previous evidence is inconclusive. It consists of introducing a catheter through a vein into the heart, where a contrast is injected, allowing the coronary circulation to be seen and the narrowing or obstruction of the arteries.

Treatment

Treatment depends on the symptoms. In any patient with coronary disease, the treatment of cardiovascular risk factors is fundamental:

  • Abandonment of tobacco.
  • Control of hypertension and diabetes, if necessary with drugs.
  • Follow a healthy diet low in cholesterol and fats. If necessary, drugs to lower cholesterol
  • Achieve an ideal body weight if you are overweight.
  • Establish a program of physical exercise appropriate to your ability.
  • Avoid stress.

The objectives of the initial medical treatment are:

  • Stabilize the patient by restoring blood flow to the myocardium and relieving symptoms
  • Prevent myocardial necrosis (death) and decrease myocardial injury
  • Reduce the risk of recurrence and complications.
  1. General measures
  • Monitoring (monitoring) of the patient’s vital signs (heart rate, blood pressure, oxygenation).
  • Oxygen administration.
  • Relief of ischemic pain with drugs.
  • Bed rest until after 12-24 hours of being symptom free.
  • Use of tranquilizers and laxatives.

Morphine, nitroglycerin and anticoagulants. Drugs to decrease cardiac activity and increase coronary irrigation: beta blockers, calcium antagonists and nitroglycerin.

  1. Pharmacological treatment

Treatment of acute coronary syndrome includes the use of drugs to combat the process of ischemia of the cardiac muscle such as beta-blockers, nitroglycerin or calcium-antagonists; Anticoagulant therapy and the use of antiplatelet agents (acetylsalicylic acid and clopidogrel) to prevent new episodes of thrombosis, and coronary revascularization.

  1. Coronary revascularization

Some patients are candidates for coronary revascularization treatments that consist of restoring blood flow through the obstructed artery. Coronary revascularization by angioplasty or surgery is performed to improve prognosis, symptoms, prevent new episodes and improve overall quality of life.

They can be performed by surgery (bypass) or by coronary angioplasty.

  • Coronary angioplasty. A catheter is inserted into the area of ​​the coronary artery which has a narrowing and dilates with a small balloon. To keep the artery open, a small metal device called the stent is placed inside. This technique cannot always be performed.
  • Treatment by Bypass surgery. Surgery is performed on the coronary arteries that allows the implantation of a piece of vein of the same (usually the saphenous vein of the calf) and implant it in the coronary ones by jumping the obstructed zone. It is performed in patients in whom angioplasty is not possible.

Prevention

Preventive measures include avoiding well-known risk factors: quitting smoking, following a healthy diet, exercising, losing weight if overweight and controlling blood pressure, cholesterol, and diabetes.

 

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