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Acute Coronary Syndrome

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  • Acute coronary syndrome

     Acute coronary syndrome is a term used for any condition brought on by sudden, reduced blood flow to the heart. Acute coronary syndrome symptoms may include the type of chest pressure that you feel during a heart attack, or pressure in your chest while you're at rest or doing light physical activity (unstable angina). The first sign of acute coronary syndrome can be sudden stopping of your heart (cardiac arrest).

    Typical symptoms

    • Chest pain (angina) that feels like burning, pressure or tightness

    • Pain elsewhere in the body, such as the left upper arm or jaw (referred pain)

    • Nausea

    • Vomiting

    • Shortness of breath (dyspnea)

    • Sudden,heavy sweating (diaphoresis)

    The signs and symptoms may vary depending on your sex, age and whether you have an underlying medical condition, such as diabetes, heart attack.

    Some additional heart attack symptoms include:

    • Abdominal pain

    • Pain similar to heartburn

    • Clammy skin

    • Lightheadedness, dizziness or fainting

    • Unusual or unexplained fatigue

    • Feeling restless or apprehensive

    Causes

    • Acute coronary syndrome is most often a complication of plaque buildup in the arteries in heart .

    • Blood clots in blood streams (embolism)

    • Cigarette smoking

    • Lack of physical activity

    • Type 2 diabetes

    High blood pressure

    • High blood cholesterol

  • Acute coronary syndrome

     Tests and diagnosis

    Electrocardiogram (ECG)

    This is the first test done to diagnose a heart attack.It's often done while you're being asked questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as "waves" displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.

    Blood tests

    Certain heart enzymes slowly leak into your blood if your heart has been damaged by a heart attack. Emergency room staff will take samples of your blood to test for the presence of these enzymes.

    Echocardiogram

    If your doctor decides you haven't had a heart attack and your risk of having a heart attack is low, you'll likely have an echocardiogram before you leave the hospital. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest.

    Chest X-ray

    An X-ray image of your chest allows your doctor to check the size and shape of heart and its blood vessels.

    Nuclear scan

    This test helps identify blood flow problems to your heart. Small amounts of radioactive material are injected into your bloodstream. Special cameras can detect the radioactive material as it is taken up by heart muscle.

    Coronary angiogram (cardiac catheterization)

    Computerized tomography (CT) angiogram

    Exercise stress test

    Treatments and Drugs

    Medications include

    • Aspirin

    Thrombolytics

    • Nitroglycerin

    • Beta blockers

    • Angiotensin-converting enzyme (ACE) inhibitors

    • Angiotensin receptor blockers (ARBs)

    Calcium channel blockers

    • Cholesterol-lowering drugs

    • Clot-preventing drugs Surgery and other procedures

    • Angioplasty and stenting

    • Coronary bypass surgery

  • Acute coronary syndrome

     Statistics

    The Canadian Acute Coronary Syndromes Registry was a prospective observational study of patients admitted with suspected acute coronary syndromes. Data on demographic and clinical characteristics, in-hospital treatment, and outcomes were recorded. At 1 year, vital status, medication use, recurrent cardiac events, and procedures were determined by telephone contact.

    Of the 5,312 patients enrolled, 4,627 had a final diagnosis of acute coronary syndrome, with Q-wave myocardial infarction in 27.7%, non–Q-wave myocardial infarction in 33.2%, and unstable angina pectoris in 39.1%.

    During hospitalization, coronary angiography and revascularization were performed in 39.6% and 20.3% of patients, respectively. The in-hospital mortality rate was 2.4% overall. At discharge, 87.8%, 76.4%, 56.0%, and 54.8% of patients were prescribed aspirin, β blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents, respectively.

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