Causes and risk factors
ACS is caused as a result of atherosclerosis. Atherosclerosis is a condition in which fatty material deposits along the walls of arteries. This fatty material thickens, hardens and form hard structures called plaques. Eventually, the plaques can make the artery narrow and less flexible, making it harder for blood to flow. Inflammatory cells especially monocytes attach to the plaque and enter the intimal layer of the blood vessel ingesting the lipid leading to formation of ‘foam cells’. It causes smooth muscle cells to migrate surrounding the plaque and form a fibrous cap. There is platelet aggregation in response to cell death and rupture in the fibrous cap. This leads to formation of thrombus or blood clot. If the clot dislodges and moves through the bloodstream, it can get stuck in the brain, lungs, heart, or other area, leading to obstruction, hampering the blood supply causing ischemia. Risk factors for ACS include diabetes, obesity, family history of heart disease, high blood pressure, high cholesterol. Being male, tobacco use, smoking, sedentary life are other contributing factors.
Clinical presentation
Acute coronary syndrome is characterised by symptoms of unstable angina or acute myocardial infarction [AMI]. The patient presents with pain in chest, even with minimal exertion or rest. There is burning, pressure and tightness in chest. Pain which is referred to other parts example chin, jaw, left arm, stomach etc. There can be nausea, vomiting, difficulty in breathing. There is profuse sweating. Additional symptoms include dizziness, fatigue, cold clammy skin, restlessness, urgency to pass urine or stool.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine blood tests, Blood tests for cardiac markers is done. Pulse oximetry is done. ECG is required which will diagnose and differentiate between AMI, NSTEMI, STEMI. Chest X ray, Echocardiography, Stress tests is advised. Surgical procedures include Coronary angiography and cardiac catheterisation.
Treatment
Unstable stable angina or ACS is a medical emergency and requires immediate hospitalization. Blood thinning medicine, medicines to control blood pressure, anxiety, abnormal heart rhythms, and cholesterol are prescribed. Angioplasty is required if there is severe blockage or narrowing of the artery which is followed by stent placement to keep the artery open. Coronary artery bypass graft [CABG] is recommended in severe cases. Additionally your doctor may recommend lifestyle modification measures such as eating heart healthy diet, regular exercise, quit smoking, and keep a check over blood pressure, blood sugar and cholesterol levels which contribute further to the treatment.
