by Dr Pandula Siribaddana

Created on: August 13, 2009   Last Updated: August 14, 2009

Acute Coronary Syndrome or ACS in short is a condition of the heart which occurs due to inadequate supply of oxygenated blood to the heart musculature. The cause for such an event would be a rupture of a cholesterol plaque and the exposed surface gives rise to platelet aggregation and formation of a thrombus or a blood clot. The event will take place suddenly, thus is named acute. The usual patients might be suffering already from angina and will feel a sudden worsening of the symptoms.

Accordingly there are three types of progression of ACS based on clinical and investigation findings. These are names Unstable Angina, ST elevation Myocardial Infarction and Non ST elevation Myocardial Infarction.

A patient with ACS will complain of following symptoms:

Angina pain: typically this will be a described as tightening, burning or pricking kind of pain and will last for several minutes. It even appears at rest and following exertion due to exercise, heavy meal or stress.

Referred pain: the pain will be noticed in the left shoulder or towards the left jaw and would be described as a shooting pain.

Shortness of breath

Nausea

Light-headedness

Associated sudden heavy sweating is also noticed

Following making a clinical diagnosis the treatment should follow quickly and this will have enormous contribution towards improving the mortality of such patients. There are several treatment options available, one such option is medical management.

Medicines:

Aspirin: Aspirin will act on the platelets and prevents the clots being formed and thus alleviating further complications through dislodging of such clots if allowed to form.

Thrombolytics: These drugs will help in the process of dissolving the platelet clots which are already formed and the earliest it is administered the better the outcome and chances of survival.

Nitroglycerines: These would act on the blood vessels by dilating the circumference and releasing any pressures from against which the heart has to pump. Therefore, it puts the heart at ease.

Beta blockers: It will relax the heart muscle, slow the heart rate and reduce the blood pressure. ACE inhibitors: These also will make the heart pump blood more easily.

Surgery: When medical treatment options are no longer doing the job or is not effective based on the level of narrowing of the blood vessels, a surgical option would be more suitable. At present two options are widely in use.

Dilatation and stenting: In this procedure a tiny wire will be inserted through an artery of the arm or the leg and guided towards the heart and reaches the blocked segment of the coronary artery. Upon arrival a balloon will be inflated and a supporting stent will be places in that position which will support the vessel walls and prevent narrowing again.

Bypass surgery: When this procedure is undertaken, a different route will be made through open surgery using a leg vein and thus bypassing the narrowed segment of the coronary artery.

Apart from the above mentioned acute management, the patient should have a healthy balanced diet which is low in fat. They also need to be engaged in healthy practices of living by avoiding smoking and other harmful habits. Regular exercises will also help in the long term care of these patients.

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