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An acute coronary syndrome (commonly known as a “heart attack”) occurs when the heart muscle does not receive oxygen and blood-borne nutrients for an extended period of time. Acute coronary syndromes develop primarily on the basis of coronary atherosclerosis, i.e. coronary disease. It is almost always associated with obstruction of the coronary artery due to plaque rupture with complete or partial blood clotting in the vessel lumen.
There are also situations in which the heart muscle has a higher energy requirement – e.g. after heavy blood loss, in anemia, systemic infections or certain arrhythmias, and failure of the body to meet these needs leads to acute coronary syndrome.
Acute coronary syndromes include:
– myocardial infarction with ST segment elevation (STEMI),
– non-ST segment elevation myocardial infarction (NSTEMI),
– unstable angina (UA),
– sudden cardiac death.
The severity of an acute coronary syndrome depends on:
– the degree and duration of the obstruction of the coronary artery,
– mass of the heart muscle involved,
– the heart muscle’s demand for oxygen and nutrients,
– the possibility for the heart to compensate for the ischemia that arises.
How to prevent acute coronary syndromes?
In order to avoid the occurrence of acute coronary syndrome, it is necessary to prevent the development of atherosclerosis.
This can be achieved by:
– quit smoking,
– weight loss (BMI less than 25)
– introducing healthy eating habits – reducing the consumption of fatty, fried foods and table salt (to less than 5 g per day), eating large amounts of fish, vegetables, fruits and cooked dishes,
– physical activity for 30 minutes a day,
– reducing alcohol consumption to less than one standard alcohol dose.
Standardization should be pursued:
– blood pressure below 140/90 mmHg,
– blood glucose levels below 110 mg / dl (6 mmol / l),
– Total cholesterol below 5 mmol / L (190 mg / dL), LDL cholesterol below 3 mmol / L (115 mg / dL).
What are the symptoms of acute coronary syndromes?
As already mentioned, acute coronary syndromes most often occur in people with coronary artery disease. It can run secretly for many years, with virtually no symptoms. The symptoms of myocardial ischemia appear only at the time of extreme narrowing or obstruction of the coronary artery, regardless of whether it has been created for many years or caused by a rupture of the atherosclerotic plaque:
– chest pain: most often located behind the breastbone, burning, crushing or choking, radiating to the left hand (or both hands), neck, jaw or abdomen.
– shortness of breath: most often occurs with exercise, but disappears with pain or when you rest
– reduced exercise tolerance: caused by a reduction in the capacity of the heart muscle
– palpitations
– excessive sweating
Stomach pain, nausea and vomiting
– fear of death
WARNING! Older people who have diabetes or kidney failure may not experience chest pain. Instead, there may only be shortness of breath, weakness, dizziness, nausea and vomiting, or disturbed consciousness. Atypical symptoms of acute coronary syndrome are more common in women.
What actions should be taken when acute coronary syndrome is suspected?
First of all, the symptoms listed above should not be underestimated. In the event of their occurrence, exercise should be stopped and 1 dose of nitroglycerin sublingually taken. If the chest pain does not improve within 5 minutes or it worsens, you should call the emergency services immediately (telephone number 112 or 999). While waiting for medical attention, you should lie down and, if you are short of breath, sit down.
How are acute coronary syndromes treated?
Depending on the type of acute coronary syndrome and the patient’s health condition, the treatment includes:
– coronary angioplasty – a special catheter with a balloon is inserted through the artery on the leg or arm to widen the closed coronary artery and additionally a stent (a metal endovascular prosthesis that looks like a spring) is inserted into it to prevent recurrence of narrowing of the artery in this place. Currently, metal stents (BMS) or drug-eluting stents (DES) are used.
– Coronary bypass (CABG) – involves implanting an additional artery or vein into the coronary artery, which “bypasses” the obstructed section, allowing blood to be delivered to the ischemic part of the heart muscle. During the operation, the chest is opened and veins or arteries from other parts of the body are often harvested.
– fibrinolytic treatment – drugs are used to dissolve the thrombus. It is a non-invasive treatment, but has a higher risk of bleeding.
– conservative treatment – can be used in patients with a low risk of death. Overall, it prevents the formation of new blood clots in the coronary arteries, stabilizes atherosclerotic plaque and reduces the burden on the heart muscle.
An indispensable part of the treatment of patients with acute coronary syndrome is cardiac rehabilitation, which usually begins during hospitalization and continues after the patient has been discharged home.
WARNING! Treatment of acute coronary syndrome can only be considered complete after full antiplatelet therapy has been administered for 12 months. It prevents re-narrowing or obstruction of the artery, especially with stenting, until it heals.
What are the complications of acute coronary syndromes?
During acute coronary syndromes, the following may occur:
– pulmonary oedema,
– rupture of the heart muscle,
– Heart arythmia,
– death.
What should I do after leaving hospital?
The most important thing after suffering from acute coronary syndrome is to prevent its recurrence. In addition to following the prescribed treatment and follow-up with a cardiologist, it is important to change your lifestyle by completely eliminating the behaviors and habits that increase your risk of coronary syndrome. If a patient has other conditions, make sure they are treated effectively. Inadequately treated diseases such as diabetes, renal failure and metabolic syndrome contribute significantly to the development of atherosclerosis.
Text: lek. Krzysztof Karwat
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