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Acute Coronary Syndrome


What is acute coronary syndrome (ACS)?

ACS is sudden decreased blood flow to your heart. This causes a lack of oxygen to your heart and can lead to unstable angina or a heart attack.

What causes ACS?

ACS is caused by narrowing of the blood vessels that carry blood and oxygen to the heart muscle. Unstable angina occurs when part of the artery is blocked, or a clot gets stuck and then breaks free. A heart attack occurs when the narrowed artery becomes totally blocked, usually by a blood clot or plaque.

What increases my risk for ACS?

  • Plaque or platelet buildup in your arteries
  • Personal or family history of coronary artery disease
  • Medical conditions, such as kidney disease, high blood pressure, or diabetes
  • Being a woman over 40 years old or man over 33 years old
  • Obesity, smoking, or lack of exercise

What are the signs and symptoms of ACS?

  • Chest pain or discomfort, including squeezing, crushing, pressure, tightness, or heaviness
  • Pain or discomfort in your arms, shoulders, neck, back, or jaw
  • Heartburn, nausea, or vomiting
  • Abdominal pain
  • Shortness of breath
  • Sweating, weakness, or fainting

How is ACS diagnosed?

  • An EKG records the electrical activity of your heart. It is used to check for abnormal heart rhythm. You may need more than one EKG.
  • Blood tests may show signs of damage to your heart muscle. These tests will be done more than once.
  • An echocardiogram (echo) is a type of ultrasound that shows the size and shape of your heart. An echo also looks at how your heart moves when it is beating. An echo can show fluid around your heart or problems with your heart valves.
  • A cardiac catheterization is a procedure to check for blockage in your arteries. A tube is threaded to your heart through a blood vessel in your leg or arm. Contrast liquid will be injected through the tube to help healthcare providers see the pictures better. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.
  • A stress test helps healthcare providers see the changes that take place in your heart while it is under stress. Healthcare providers may place stress on your heart with exercise or medicine.

Which medicines are used to treat ACS?

  • ACE inhibitors and beta-blockers keep your blood vessels open and help your heart pump strongly and regularly.
  • Cholesterol medicine helps lower the amount of plaque buildup in your arteries.
  • Blood pressure medicine helps decrease the strain on your heart.
  • Pain medicine helps decrease your pain and slows your heart rate.
  • Blood thinners help prevent blood clots. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take a blood thinner. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any other medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Take your blood thinner exactly as prescribed by your healthcare provider. Do not skip does or take less than prescribed. Tell your provider right away if you forget to take your blood thinner, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin:
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
  • Thrombolytics help break apart and dissolve clots.
  • Nitroglycerin opens the arteries to your heart so the heart gets more oxygen. It is given as a pill, IV, or topical patch or paste.

What are some other treatments for ACS?

  • An angioplasty is a procedure to open an artery blocked by plaque. 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 so blood can flow through it.
  • Coronary intravascular stent placement is usually done during an angioplasty. A stent is a hollow tube made of wire mesh that is put into a coronary artery. The stent supports the artery and keeps it open so blood can flow through it.
  • Coronary artery bypass graft surgery (CABG) is open-heart surgery. A graft is used from another artery in your body to replace the blocked one.
  • Cardiac rehab is a program that teaches you how to live a more heart-healthy lifestyle, including nutrition and exercise.

How can I help prevent ACS?

  • Eat a variety of healthy, low-fat foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask for more information about a heart healthy diet.
  • Ask about activity. Your healthcare provider will tell you which activities to limit or avoid. Ask when you can drive, return to work, and have sex. Ask about the best exercise plan for you.
  • Maintain a healthy weight. Ask your healthcare provider how much you should weigh. Ask him to help you create a weight loss plan if you are overweight.
  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause heart and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Get the flu and pneumonia vaccines. All adults should get the influenza (flu) vaccine. Get it every year as soon as it becomes available. The pneumococcal vaccine is given to adults aged 65 years or older. The vaccine is given every 5 years to prevent pneumococcal disease, such as pneumonia.

Call your local emergency number (911 in the US)for any of the following:

  • You have any of the following signs of a heart attack:
    • Squeezing, pressure, or pain in your chest
    • You may also have any of the following:
      • Discomfort or pain in your back, neck, jaw, stomach, or arm
      • Shortness of breath
      • Nausea or vomiting
      • Lightheadedness or a sudden cold sweat
  • You have any of the following signs of a stroke:
    • Numbness or drooping on one side of your face
    • Weakness in an arm or leg
    • Confusion or difficulty speaking
    • Dizziness, a severe headache, or vision loss

When should I contact my healthcare provider?

  • You have questions or concerns about your condition or care.

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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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