Acute coronary syndrome: symptoms and treatment


Acute coronary syndrome is a pathological process in which the natural blood supply of the myocardium is broken or completely ceased through the coronary arteries. In this case, oxygen does not flow to the cardiac muscle at a certain site, which can lead not only to a heart attack, but also to a fatal outcome.

The term «OCS» is used by clinicians to refer to certain ailments of the heart, including myocardial infarction and unstable angina. This is due to the fact that the etiology of these diseases is coronary insufficiency syndrome. In this condition, the patient needs emergency medical attention. In this case, we are talking not only about the development of complications, but also the high risk of death.

Etiology

The main cause of the development of acute coronary syndrome is the defeat of atherosclerosis of the coronary arteries.

In addition, there are such possible factors for the development of this process:


  • severe stress, nerve strain
  • Vascular spasm
  • narrowing the lumen of the vessel
  • mechanical damage to the body
  • postoperative complications
  • coronary artery embolism
  • coronary artery inflammation;
  • congenital pathologies of the cardiovascular system.

Separately, there are factors that are predisposing to the development of this syndrome:


  1. overweight, obesity;
  2. smoking, drug use
  3. Almost no physical activity
  4. violation of the balance of fats in the blood;
  5. alcoholism
  6. genetic predisposition to cardiovascular pathologies
  7. increased blood clotting
  8. frequent stress, constant nervous tension
  9. high blood pressure;
  10. diabetes;
  11. taking certain medications that lead to a decrease in pressure in the coronary arteries (coronary steal syndrome).

ACS is one of the most dangerous conditions for a person’s life. In this case, not only urgent medical care is required, but also urgent resuscitation. The slightest delay or wrong actions of the first aid can lead to a lethal outcome.

Pathogenesis

Because of the thrombosis of the coronary vessels, which is provoked by a certain etiological factor, the biologically active substances — thromboxane, histamine, thromboglobulin — start to be released from the platelets. These compounds have a vasoconstrictive effect, which leads to a worsening or complete cessation of the blood supply to the myocardium. This pathological process can be aggravated by adrenaline and calcium electrolytes. At the same time, the anticoagulant system is blocked, which leads to the production of enzymes that destroy cells in the necrosis zone. If at this stage the development of the pathological process is not stopped, then the affected tissue is transformed into a scar which will not participate in the contraction of the heart.

The mechanisms of development of acute coronary syndrome will depend on the degree of overlap with a thrombus or plaque of the coronary artery. Allocate the following stages:


  • with partial reduction of blood supply, anginal episodes may be observed periodically;
  • With complete overlap, dystrophy sites occur that later become necrosis, leading to a heart attack
  • sudden pathological changes — lead to ventricular fibrillation and, as a consequence, clinical death.

We must also understand that a high risk of death is present at any stage of the development of ACS.

Classification

Based on the current classification, these clinical forms of ACS are distinguished:


  1. Acute coronary syndrome with ST segment elevation — the patient has typical ischemic pain in the chest, reperfusion therapy is required
  2. Acute coronary syndrome without ST segment elevation — typical for ischemic disease changes, attacks of angina pectoris. Thrombolysis is not required;
  3. myocardial infarction diagnosed by enzyme changes
  4. unstable angina

The forms of acute coronary syndrome are used only during the diagnosis.

Symptoms

The first and most characteristic sign of the disease is acute pain in the chest. Pain syndrome can be of a paroxysmal nature, given in the shoulder or arm. With angina, the pain by nature will be compressive or burning and short-lived in time. With myocardial infarction, the intensity of the manifestation of this symptom can lead to painful shock, therefore immediate hospitalization is required.

In addition, the clinical picture may present such symptoms:


  • cold sweating
  • unstable blood pressure;
  • excited state
  • confusion
  • Panic fear of death
  • faint;
  • pale skin;
  • The patient feels a lack of oxygen.

In some cases, the symptomatology may be supplemented with nausea and vomiting.

In such a clinical picture, the patient needs to urgently provide first aid and call for emergency medical care. The patient should never be left alone, especially if there is nausea with vomiting and loss of consciousness.

Diagnostics

The main method for diagnosing acute coronary syndrome is electrocardiography, which must be done as soon as possible from the onset of a pain attack.

The full diagnostic program is performed only after it was possible to stabilize the patient’s condition. Be sure to notify the doctor about what medications were given to the patient as the first medical aid.

The standard program of laboratory-instrumental examinations includes the following:






  1. general blood and urine analysis
  2. biochemical blood test — the level of cholesterol, sugar and triglycerides is determined;
  3. coagulogram — to determine the level of coagulation of blood
  4. ECG — an obligatory method of instrumental diagnosis in ACS
  5. echocardiography
  6. coronary angiography — to determine the location and extent of coronary artery constriction

Treatment

Therapy program for patients with acute coronary syndrome is selected individually, depending on the severity of the pathological process, hospitalization and strict bed rest are mandatory.

The condition of the patient may require the provision of emergency first aid, which is as follows:


  • provide the patient with complete peace and fresh air;
  • put a nitroglycerin tablet under your tongue
  • call for an emergency medical care by reporting symptoms.

Treatment of acute coronary syndrome in a hospital may include such therapeutic measures:


  1. inhalation with oxygen
  2. Administration of medications.

Within the framework of drug therapy, a doctor can prescribe such drugs:


  • narcotic or non-narcotic painkillers
  • anti-ischemic;
  • beta blockers;
  • calcium antagonists;
  • nitrates;
  • Disaggregants
  • statins
  • fibrinolytics

In some cases, conservative treatment is not enough or it is not at all appropriate. In such cases, the following surgery is carried out:


  1. Stenting of the coronary arteries — a special catheter is performed to the site of constriction, after which a lumen expands with the help of a special balloon, and a stent is placed in the narrowing place
  2. Aortocoronary bypass — coronary arteries are replaced by shunts

Such medical measures make it possible to prevent the development of myocardial infarction from ACS.

In addition, the patient must follow general recommendations:


  • strict bed rest until stable improvement;
  • complete exclusion of stress, strong emotional experience, nervous tension
  • exclusion of physical activities
  • As the condition improves, daily walks in the open air
  • exclusion from the diet of fatty, acute, too salty and other heavy food
  • complete exclusion of alcoholic beverages and smoking.

It should be understood that acute coronary syndrome, if the doctor’s recommendations are not observed, can lead to serious complications at any moment, and the risk of a lethal outcome with relapse is always preserved.

Separately, we should highlight diet therapy in ACS, which implies the following:


  1. restriction in the consumption of products of animal origin
  2. the amount of salt should be limited to 6 grams per day;
  3. exclusion of too spicy, flavored dishes

It should be noted that compliance with this diet should be constantly, both during the treatment period and as a preventive measure.

Possible complications

The syndrome of acute coronary insufficiency can lead to the following:


  • heart rhythm disturbances in any form
  • development of acute heart failure, which can lead to death
  • pericardial inflammation;
  • aortic aneurysm

It should also be understood that even with timely medical measures, there is a high risk of developing the above complications. Therefore, such a patient should be systematically examined by a cardiologist and strictly follow all his recommendations.

Prevention

To prevent the development of cardiovascular disease can be, if you follow in practice such recommendations of doctors:


  1. complete quitting, moderate consumption of alcoholic beverages
  2. proper nutrition;
  3. moderate exercise;
  4. Daily walks in the open air
  5. exclusion of psychoemotional loads
  6. blood pressure monitoring
  7. cholesterol level control

In addition, we should not forget the importance of preventive examination by specialized medical specialists, observance of all the doctor’s recommendations regarding the prevention of diseases that can lead to the syndrome of acute coronary insufficiency.

Applying a minimum of recommendations in practice will help prevent the development of complications that are provoked by an acute coronary syndrome.