ACS: Acute Coronary Syndrome

Acute coronary syndrome is a new general term. Thirty years ago my father died from three consecutive heart attacks at the age of 36. In my work, I see countless people afflicted with the disease. Some are older, some are younger, even some that eat well. Most of the people do live a lifestyle that is unhealthy. It is the unhealthy lifestyle in which we can change.

It encompasses angina, both stable and unstable and acute myocardial infarction (AMI) or heart attack. When we talk about an acute myocardial infarction we use terms like non ST elevation MI (NonSTEMI) or ST elevation MI (STEMI). It can get complicated so I will just touch on it here.

Acute coronary syndrome is all encompassing to include all of the above and more. In simple terms, it has to do with the blood flow or lack of it. It is just an easier way for doctors to classify and categorize the damage to the heart.

We will examine each of the major parts of acute coronary syndrome in the rest of the page as sort of snippets. We will start with angina since it is the first thing that I mentioned up above. Angina comes in two flavors: stable and unstable. To sum it up angina is a diminished blood flow to the heart muscle. The cardiac cells need a lot of energy to pump and work well. The blood vessels supply that energy and when supply is less than demand, the heart gets ticked and throws a tantrum. The tantrum is felt as pain, “I want my food!” The blood vessels want to give it to the heart but somewhere there is a slowing of blood. There is no clog yet, but the blood sure is slow and the heart is angry. So in angina the blood vessels narrow which allows some food and energy to get through but not enough to feed the heart of all its nutrition. So far so good? I’ll take your silence as a yes!

Stable angina is pain that is felt from the heart that goes away with rest and comes with exertion. So typing at the computer all day might be fine as there is not enough of a workload increase to set the heart off. Throw in a game of tennis and the whole ball game changes. The heart suddenly needs a lot of energy and with the vessels being narrowed it brings on chest pain like you wouldn’t believe. Then you rest and the heart rate slows down and the demand for energy is lessened and the pain goes away. If chest pain is controlled this way then it might be stable angina.

Unstable angina is pain that is felt while at rest. You’re sitting there watching T.V. and suddenly you feel this immense pressure on your chest like an elephant just plunked itself on your chest for a midday snooze. You get sweaty and nauseated and suddenly you think I’m having a heart attack, “I’m going to die!” Scary to say the least. This type of pain may just as severe as a heart attack. You will not know the difference unless you go to the doctor or even better the emergency room. You might see me! If it is under these circumstances, I would rather not see you, no offence! Unstable angina comes on while at rest and may not go away and can be unpredictable or unstable.

Acute myocardial infarction (AMI) is the big daddy of heart disease. It is what everyone is talking about. The heart attack! When we talked about angina up above we talked about pain and pressure, which can feel exactly the same as a heart attack or AMI. It can also feel like indigestion or squeezing or you may even just get short of breath. Two people can have the exact size of attack and feel completely different symptoms. With everything else being equal physically, the interpretation of the disease is different in each person. Firstly, what is AMI? The blood vessels are going along delivering their energy to the heart, the slow-down is there and they attempt to bypass it to get the delivery to the heart on time but the vessels can’t. Then one little blood cell takes a wrong turn causes a pile up and blocks off the entire section of the blood vessel. Now there is a complete blockage and there is no way anything can get through. The heart gets angry goes into its tantrum which you feel as pain or discomfort. So the only difference between angina and heart attack is in angina there is a narrowing and in AMI there is a complete blockage. How do you know if you’re having angina symptoms or a heart attack? Good question and the answer is… you don’t, so go to the hospital.

ST elevation on an ECG shows nurses and doctors that damage is occurring or has had occurred. Below is a picture of an ECG showing ST elevation or STEMI in blue.

You have generally three hours to get yourself to a hospital with the onset of pain. Why? Anyone? If you are having a heart attack with a blockage in your heart as determined by an ECG showing a STEMI; then we can give a drug that will bust up that clot but it can only be safely given within three hours of pain. If the criteria are right and you fit the profile of the drug then the clot could be busted up and it will be like the heart attack never happened. Three hours remember that, three hours to get to a hospital and your heart can be saved.

There is another way you heart can be saved, it can be saved through active participation of your health. Through regular visits with your doctor, going through cardiac risk factors and managing your risk. Acute coronary syndrome can be managed through exercise and daily physical activity that maintains your heart of 65% of maximum for at least 20 minutes a day. You can save your heart now! Everybody has some sort of narrowing that is going on in their blood vessels some are worse than others. It is better to be proactive with your health, stop problems before they start, so we don’t have to meet in the hospital…No offence!

Return from acute coronary syndrome to Cardiac Diseases

Return from acute coronary syndrome to Heart Disease and Prevention Home Page

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