Acute Coronary Syndromes

What is it?

• Acute coronary syndromes (ACS) is a word used for many different types of sudden heart disease. These forms of heart disease all cause a lack of oxygen to your heart. This lack of oxygen may cause pain, damage, or death to your heart. ACS may include the following:
  
  
  • Unstable angina: This is chest pain or discomfort that occurs at rest or with very little activity. The pain may come on sooner, last longer, or be worse than usual. It may not go away with rest or medicines.
    
    
  • Heart attack with abnormal EKG: This type of heart attack shows signs of heart muscle damage on your electrocardiogram (EKG). Blood tests also show signs of heart muscle damage.
    
    
  • Heart attack with normal EKG: This type of heart attack looks normal on your electrocardiogram (EKG). However, blood tests show signs of heart muscle damage.
  
  
• If you have signs and symptoms that may be ACS, contact your doctor right away. Contact your doctor even if your pain or any odd feeling has gone away. Your doctor may check you and do some tests. Your doctor will suggest the best treatment for you.

What causes ACS?

ACS is caused by narrowing of the blood vessels that carry blood, oxygen and nutrients to the heart muscle. A heart attack occurs when the narrowed artery becomes totally blocked, usually by a small blood clot or piece of plaque. Unstable angina occurs when part of the artery is blocked, or a clot gets stuck and then breaks free. Plaque builds up in the arteries of the heart and in all arteries with age. The following may increase your risk of getting ACS:

• Having blood vessel disease.
  
  
• If you or someone in your family has coronary artery disease.
  
  
• Having high blood pressure, high cholesterol and diabetes.
  
  
• Being a woman over 40 years old, or man over 33 years old.
  
  
• New or increased time periods when you have signs and symptoms of ACS.
  
  
• Not exercising, being overweight, and smoking.
  
  
• If you are a woman going through menopause.

What are the signs and symptoms of ACS?

• Chest pain or discomfort, including squeezing, crushing, pressure, tightness or heaviness in the chest.
  
  
• Pain or discomfort in your arms, shoulders, neck, back or jaw.
  
  
• Indigestion, such as heartburn and upset stomach.
  
  
• Nausea and vomiting.
  
  
• Pain in your abdomen.
  
  
• Shortness of breath.
  
  
• Sweating, weakness or fainting.

What tests are done for ACS?

You may have one or more of the following tests:

• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Blood tests: Your doctor will order blood tests to look for signs of damage to your heart muscle. These tests will be done more than once.
  
  
• Cardiac catheterization: This is a test to see if there is any blockage in your heart arteries. A tube is threaded to your heart through a blood vessel in your leg or arm. Dye will be injected through the tube. The dye helps the x-ray pictures of your arteries to show up better on a TV-like screen.
  
  
• Echocardiogram: This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. An echo can show fluid around your heart or problems with your heart valves.
  
  
• Exercise stress test: Stress tests are not done if you are having a heart attack, but may be done at a later time. A stress test helps caregivers see the changes that take place in your heart during exercise. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have trouble breathing or have chest, arm, jaw, or back discomfort.
  
  
• Stress test with medicine: If you cannot walk or exercise, you may be given medicine that causes your heart to work harder. A stress test machine will be used to show how your heart works while you take the medicine.

How are acute coronary syndromes treated?

You may have one or more of the following treatments depending on what your tests show.

• Angioplasty: This is also called percutaneous transluminal coronary angioplasty or "PTCA." Angioplasty is a treatment that may be needed to open up an artery (blood vessel) blocked by plaque. Plaque is fatty material inside your arteries. A tube with a balloon on the end is threaded into the blocked artery. The balloon is filled with liquid which presses the plaque against the artery wall. This opens the artery up so blood can flow through it.
  
  
• Coronary intravascular stent placement: This procedure is often done during a PTCA. A stent is a hollow tube made of wire mesh that is put into a coronary artery. It helps to keep the artery open so blood can flow through it.
  
  
• Coronary artery bypass surgery: Coronary artery bypass surgery (CABG) is open-heart surgery. A CABG is usually done because one or more of the arteries on your heart are blocked.
  
  
• Cardiac rehabilitation: Cardiac rehabilitation includes information about cardiac disease, medicines, and lifestyle changes you may need to make. It also includes exercise programs which may be done in a rehabilitation center or at home.

What medicines are available for ACS?

You may need one or more of the following medicines:

• ACE inhibitors: These are medicines that keep your blood vessels relaxed and open. They help keep oxygen-rich blood flowing into your heart. These medicines may be used to treat high blood pressure.
  
  
• Anti-coagulants: This medicine helps keep the blood from clotting and closing partly blocked arteries.
  
  
• Anti-platelet medicines: Anti-platelet medicines, such as aspirin, keep platelets from sticking to a damaged part of your artery. Sticky platelets may cause a blockage in your artery and keep blood from going to your heart muscle.
  
  
• Beta-blockers: Beta-blockers keep your heart pumping strongly and regularly and may also lower your blood pressure.
  
  
• Blood pressure medicine: This is given to lower your blood pressure. A controlled blood pressure helps protect your organs, such as your heart, lungs, brain, and kidneys. Take your blood pressure medicine exactly as directed.
  
  
• Cholesterol lowering medicines: These medicines may help to lower cholesterol that causes coronary artery disease.
  
  
• Clot busters: This medicine helps break apart clots. It is given IV and may be given at the same time as other blood thinners. This medicine could save your life because blood clots in the heart, lungs or brain can kill you. Be careful because you may bleed or bruise easily.
  
  
• Diabetes medicine: This medicine may be given to control the amount of sugar in your blood. It helps your body move the sugar from the blood to your cells, where it is needed for energy.
  
  
• Morphine: Morphine will relieve pain and help your breathing. Morphine makes it easier for your heart to work.
  
  
• Nitroglycerin: This medicine may also be called nitro. Nitroglycerin opens the arteries to your heart so the heart gets more oxygen. Nitroglycerin can be given in an IV, by mouth, or put on your body as a patch or paste.

What can I do to prevent ACS?

• Eat low-fat foods. Ask your caregiver for information about a health heart diet.
  
  
• Exercise regularly.
  
  
• Lose weight.
  
  
• Stop smoking.
  
  
• Talk to your doctor about taking medicine for high cholesterol. Diet and exercise may not lower your cholesterol enough. Cholesterol medicines may help prevent further cholesterol build up in the arteries.
  
  
• Treat health problems such as high blood pressure and diabetes.
  
  
• Take your medicines as directed by your doctor.
  
  
• If you experience any signs or symptoms of ACS, call 911 right away. You may need an ambulance to take you to the hospital. Do not drive yourself.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Acute Coronary Syndromes