Understanding Acute Coronary Syndrome

Understanding Acute Coronary Syndrome: Exploring Symptoms, Diagnostics, Treatment Options, and Complications

Acute coronary syndrome (ACS) is a collective term that encompasses various conditions resulting from the reduction of blood supplied to the heart, causing potential injury to the heart tissue. Among its components are ST-elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. Here, we delve into the key aspects of ACS, including symptoms, diagnostics, treatment options, and complications.

Symptoms

The primary symptom of ACS is typically chest pain or discomfort, frequently referred to as angina. However, symptoms may vary and even absent in certain individuals, especially women, older adults, and those with diabetes. Other common signs include shoulder or arm pain, shortness of breath, nausea or vomiting, indigestion, racing pulse, lightheadedness, and fainting.

Diagnostic Approaches

Diagnosing ACS requires a comprehensive approach, taking into account the patient's history, physical examination findings, electrocardiogram (ECG), and cardiac biomarker tests. ACS is classified based on whether the ischemia leads to detectable myocardium damage through ECG changes and elevated levels of creatine kinase MB (CK-MB).

Treatment Strategies

The ultimate goal of ACS management is to restore adequate blood flow to the heart, treat complications, and prevent further issues. Initial steps usually involve administering aspirin, nitrates, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Depending on the patient's condition, treatments may include percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or conservative management based on specific risks and renal function considerations.

Complications

Despite treatment efforts, complications associated with ACS remain significant. These can be broadly classified into mechanical dysfunction, electrical dysfunction, and inflammatory complications. Mechanical dysfunction includes heart failure (HF), myocardial rupture (e.g., aneurysm formation), and papillary muscle dysfunction. Electrical disorders encompass tachycardia, Mobitz type II block (second degree) or complete (third degree) atrioventricular (AV) block, ventricular tachycardia (VT), and bradyarrhythmias. Additionally, inflammatory complications such as pericarditis and post-myocardial infarction syndrome (Dressler syndrome) further contribute to morbidity and mortality in ACS patients.