Acute coronary syndrome

Acute coronary syndrome . It includes three groups of conditions: acute unstable angina pectoris , acute myocardial infarction, and sudden cardiac death. The most common way of presenting is the so-called anginal pain (in the chest).

The unstable angina , the heart myocardium with or without wave Q constitute the so – called acute coronary syndrome (ACS). These entities have a common pathophysiological relationship and represent different stages of fissure, rupture, and thrombus formation in the atherosclerotic plaque. If not treated aggressively, unstable angina progresses towards death in 5 to 10% of patients and non-fatal infarction in 10 to 20%, these events occurring in the first days to weeks of the onset of symptoms.

Summary

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  • 1 Triggering causes
  • 2 Signs and symptoms
  • 3 Clinical characteristics
  • 4 Exams
    • 1 Physical exam
    • 2 Electrocardiogram
    • 3 Echocardiography
  • 5 Treatment
  • 6 Behavior and way to prevent acute coronary syndrome
  • 7 Sources

Trigger causes

Atheromatous lesions of the coronary arteries begin early in life and generally take many years of “maturation” for them to be responsible for producing myocardial ischemia. It is thrombosis superimposed on an atherosclerotic plaque that modifies the relatively benign evolution of a disease, turning it into an unstable condition responsible for ACS.

The condition is due to the formation and rupture of the atheroma plaque (accumulation of fats) in the coronary arteries, which produces a thrombus (blood clot) capable of totally or partially blocking blood flow to the heart . It usually occurs in the fifth and sixth decades of life in men and 10 years later in women. The studies of the coronary arteries carried out in living people and the findings in the deceased, agree that more than 95% are due to atherosclerosis .

Signs and symptoms

Myocardial ischemia (deficiency of irrigation of the heart) is usually manifested by pain or tightness in the chest , causing arrhythmias —so called disorders in the formation and conduction of electrical impulses that govern the heart rhythm— , which can cause sudden death or varying degrees of heart malfunction . Based on the above, the most common manifestations, in addition to chest tightness, may be shortness of breath, profuse sweating, palpitations, fainting, loss of consciousness and hypotension (decrease in blood pressure).

Clinical features

Ischemic pain in angina episodes is described as a feeling of discomfort or tightness loosely localized to the chest or arm associated with physical activity or emotional stress and is quickly relieved (less than 5 minutes) with rest and / or the use of sublingual nitroglycerin.

Exams

People with chest pain undergo an EKG immediately. If this presents unequivocal signs of coronary insufficiency, thrombolysis (administration of a substance that dissolves the intracoronary clot or thrombus) is performed, if the patient does not present contraindications to this medication. Another alternative treatment is coronary angioplasty: the removal of the thrombus with the help of a catheter.

Physical exam

In general, it does not provide important data unless associated clinical manifestations of heart failure or cardiogenic shock occur. It allows ruling out certain conditions that cause secondary angina.

Electrocardiogram

This is the most widely used test for evaluating chest pain. It should be remembered that it is used to confirm the initial clinical impression and not as the only means of obtaining a diagnosis.

Echocardiography

Very useful study to obtain information on systolic function and segmental contractility disorders. It should be remembered that an injury that involves more than 20% of the thickness of the myocardial wall is required for an alteration of segmental contractility to be detected by echocardiography . This technique does not distinguish ischemia from heart attack , nor recent injuries from old ones.

Treatment

The management of ACS has become multifactorial because the therapy is aimed at the different pathophysiological stages that trigger this Syndrome, from plaque activation, ischemia to cell necrosis. In patients presenting with ST-elevation MI, restoration of flow to the myocardium with dissolution of the thrombus by thrombolysis is of paramount importance. In patients with unstable angina or MI without ST elevation, plate stabilization to prevent disease progression, recurrence of thrombosis and vasoconstriction are mandatory.

Behavior and way to prevent acute coronary syndrome

Heart disease is the leading cause of death in Cuba and of these, acute myocardial infarction represents 82%. Now, the coronary syndrome can be avoided by acting on the causes that cause it, which is called “coronary risk factors”, and modifying the lifestyle with adequate control of hypertension , diabetes mellitus , abandoning the smoking , consumption of excess salt and fats of animal origin and also increase the consumption of vegetables , fruits and vegetables. To maintain good health it is enough to walk three kilometers daily.

 

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