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Acute Coronary Syndrome

  • Acute coronary syndrome

     Acute coronary syndrome (ACS) refers to a group of conditions due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.

    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.


    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


    The Italian network on acute coronary syndromes outcome (IN-ACS Outcome) study is a nationwide observational, multicenter study with the aim to describe clinical epidemiology, management, 30-days and one-year outcomes of ACS in Italy. All consecutive patients admitted for ACS to 38 hospitals, between December 2005 and February 2007, were enrolled in the study.

    Patient in-hospital details and follow-up data at 30-days and one-year were collected using a web-based CRF and stored in a central database. A total of 6045 patients (age 68 ± 13 years) were enrolled: 2313 patients (38.3%) had ST elevation myocardial infarction (STEMI) and 3732 (61.7%) patients had NSTE-ACS.

    Primary PCI was performed in 1085 (46.9%) STEMI patients, thrombolysis in 590 (25.5%) patients, whereas 638 (27.6%) patients were not reperfused. Among patients with NSTE-ACS, coronary angiography was performed in 2797 (75%) patients, PCI in 1797 (48.2%) patients and CABG in 213 (5.7%) patients. Thirty-days and one-year mortality rates were 5.8% and 9.8%, in STEMI patients and 3.1% and 8.6%, in NSTE-ACS patients.

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