The term acute coronary syndrome (ACS for short) refers to various cardiovascular diseases that are very similar in their symptoms and therefore not always directly distinguishable. All diseases are caused by an occlusion or narrowing of the coronary arteries.
What characterizes acute coronary syndrome?
The cardiovascular diseases of acute coronary syndrome include unstable angina, nontransmural as well as transmural myocardial infarction, and sudden cardiac death. Acute coronary syndrome cardiovascular diseases include unstable angina, non-transmural as well as transmural myocardial infarction and sudden cardiac death. In the initial phase, the symptoms of the diseases are very similar and cannot be differentiated with certainty. For this reason, the term “acute coronary syndrome” is generally used when there is still unexplained cardiac symptomatology that lasts longer than 20 minutes. Fifteen percent of emergency patients with an initial diagnosis of “acute coronary syndrome” have suffered a myocardial infarction, or heart attack.
Causes
The cause of coronary syndrome diseases is an acute circulatory disorder of the coronary arteries. The coronary vessels, also called coronary arteries, entwine around the heart like a wreath. They originate from the aorta (main artery) and supply the heart muscle with oxygen. If the coronary vessels become narrowed or even blocked, the heart no longer receives sufficient oxygen and can only maintain its function to a limited extent or not at all. In most cases, this is caused by arteriosclerosis, also known as hardening of the arteries. In arteriosclerosis, deposits of blood fats, calcium, blood clots or blood lipids occur in the walls of arterial vessels. These deposits are also called plaques. Atherosclerosis can occur in all arterial vessels of the body. If it occurs in the coronary arteries, it is also called coronary artery disease. The consequence of these deposits is a narrowing of the vessel lumen and a loss of vascular elasticity. Risk factors for the development of arteriosclerosis are high cholesterol levels, elevated blood lipid levels, smoking, diabetes mellitus, high blood pressure and early heart attacks in the family. Obesity and an unhealthy lifestyle with a lot of stress and a high-fat diet also play a role. Environmental pollution such as noise at night or an increased concentration of particulate matter in the air is also thought to have an influence on the development of atherosclerosis.
Symptoms, complaints, and signs
If there is a mismatch between the blood flow to the coronary arteries and the oxygen and nutrient requirements of the heart, angina pectoris develops. The symptoms often begin during or immediately after exertion. Difficult-to-digest meals or psychological stress can also trigger angina pectoris. In the case of unstable angina pectoris, the attacks occur even from resting situations. Angina pectoris manifests itself in severe and burning pain, usually localized behind the breastbone. The pain may also radiate to the left shoulder, upper left arm or upper abdomen. Sufferers experience a sense of annihilation and suffer from fear of death. The attacks usually last no longer than fifteen minutes. The use of nitrospray brings immediate improvement. Myocardial infarction often initially presents like an angina attack. The pain is similarly localized but more severe and increases continuously. Even with the administration of nitrospray, the symptoms do not improve or improve only very briefly. The affected person is pale or even cyanotic (blue). The pulse can be slow, fast or normal. It is often unrhythmic. Dizziness, nausea or vomiting may also occur. Pulmonary edema or shock may occur. However, myocardial infarction does not always manifest itself in these typical ways. In patients with diabetes mellitus, the infarction is often completely painless and is only noticeable through slight nausea. It is also not uncommon for women to complain only of nausea or vomiting. Characteristic is an occurrence in the early morning hours. Sudden cardiac death is probably the most dramatic manifestation of acute coronary syndrome. Here, death from heart failure occurs within a few minutes.
Diagnosis and course
Acute coronary syndrome disease is diagnosed by ECG.Various laboratory parameters such as myoglobin, troponin or CK-MB also provide information on whether the symptoms are angina pectoris or a heart attack. Coronary angiography is performed to assess the severity of coronary heart disease. Here, the interior of the coronary arteries is made visible with the aid of a contrast medium. In this way, occlusions or narrowings can be diagnosed unerringly.
Complications
Coronary syndrome can result in acute or chronic complications. One possible acute complication is myocardial rupture. This involves a tear in the heart muscle. The condition is life-threatening. As a consequence of acute coronary syndrome, the formation of a ventricular septal defect is possible. The septum between the heart chambers is damaged. As a result, the pressure conditions in the systemic and pulmonary circulation are affected. An increase in pressure in the pulmonary circulation or a reduced pumping capacity of the heart can be consequences of the ventricular septal defect. A possible acute complication of coronary syndrome is papillary muscle rupture. The papillary muscles fix the heart valves. Tearing of the muscle impairs the function of the affected valve. Acute heart failure may result. Pericarditis or hemorrhage into the pericardium (pericardial effusion) are further possible complications of acute coronary syndrome. A feared sequela is thromboembolism. This results in blood clots which, in extreme cases, can trigger a stroke. The most common chronic consequence of coronary syndrome is heart failure. The pumping capacity of the heart is reduced. The patient is sometimes considerably restricted in daily life by shortness of breath. Cardiac arrhythmias can be a complication of acute coronary syndrome. The heart rate may be accelerated (tachycardia) or slowed (bradycardia). All complications of acute coronary syndrome can occur despite treatment for the condition.
When should you see a doctor?
Because acute coronary syndrome is usually a very serious complaint and disease, it must always be examined and treated by a physician. There will be no spontaneous recovery and the affected person may die of heart failure or cardiac death in the worst case. In most cases, the patient will experience pain and feelings of pressure in the chest. Therefore, if there is any discomfort in the heart, it must be treated immediately. In cases of emergency or acute pain, an emergency physician must be called or a hospital must be visited directly. Immediate treatment is also essential in the event of breathing difficulties, fear of death or nausea. In the case of sudden cardiac death, however, no further treatment is possible and the affected person usually dies. In acute coronary syndrome, therefore, a cardiologist must be consulted. However, in case of severe pain, immediate surgery or resuscitation measures are necessary. This is true even if the affected person has already lost consciousness.
Treatment and therapy
Acute angina pectoris is usually treated with nitro preparations. This dilates the blood vessels in the body and thus also the coronary vessels. Thus, an improvement of the symptoms occurs quickly. A neurostimulator can also be used. A neurostimulator is a small device that is implanted under the skin in the abdomen. During an attack, the patient can turn on the neurostimulator. This then sends electrical impulses to the spinal cord. These electrical signals cause pain modulation. If the symptoms do not disappear or fade within a short time, the emergency doctor should be called, as it could be a heart attack. This requires rapid action and intensive medical care. In the hospital, either lysis therapy to dissolve artery-clogging blood clots or implantation of a stent using a balloon catheter is performed.
Outlook and prognosis
Acute coronary syndrome usually results in various cardiac and circulatory complications. In many cases, the syndrome cannot be diagnosed directly because there are no clear symptoms or signs. There is usually severe and burning pain in the shoulder or upper arm. Sometimes there is a panic attack or the so-called feeling of death and the affected person suffers from sweating. In addition, there is severe nausea associated with vomiting.The affected person appears pale and listless and not infrequently suffers from concentration disorders. In most cases, treatment is acute with the help of medication. It can quickly limit the symptoms. In the case of long-term treatment, a neurostimulator is used, which should prevent the death of the patient. Furthermore, a heart attack can also occur, which can lead to death. In most cases, the patient’s life expectancy is limited by the coronary syndrome.
Prevention
The primary prevention goal is to reduce risk factors of acute coronary syndrome. Affected individuals should increase their physical activity, change their diet, and refrain from smoking. In addition, drug support is usually given. Antiplatelet drugs are used for this purpose. These are intended to prevent the formation of blood clots in the arteries. Cholesterol-lowering drugs are also used. This is intended to lower the LDL cholesterol (colloquially “bad cholesterol”), which damages the blood vessels, in favor of the HDL cholesterol (colloquially “good cholesterol”), which protects the blood vessels.
Follow-up
While acute coronary syndrome must be treated promptly by medical attention, patients must also be consistently involved in follow-up care. This is because aftercare in this serious clinical picture means minimizing the likelihood of a recurrence as best as possible through healthy behavior in everyday life. This cooperation of the patient in the context of secondary prevention means a bundle of measures that is tailored to the patient’s needs and always discussed with the attending physician. This starts with a healthy diet that supports the vascular and cardiovascular systems in their functions and can also achieve any necessary weight reduction. Abstaining from nicotine and alcohol are important factors in recovery from acute coronary syndrome. A healthy amount of exercise is also necessary, especially for overweight patients. Here, too, the heart and circulation are vitalized and weight is built up. In addition, the immune system is strengthened and susceptibility to infection is reduced. Exercise in coronary sports groups can be specifically tailored to the problems of the individual patient. Information about groups can be obtained from general practitioners, internists and cardiologists. Stress has an unfavorable effect on acute coronary syndrome. For this reason, relaxation techniques are also important aids in the context of targeted aftercare. Here, autogenic training, progressive muscle relaxation and yoga are among the methods that can effectively relieve the patient’s psychological tension.
What you can do yourself
In the case of an acute coronary, the affected person can contribute a lot to the stability of his or her immune system through a healthy and balanced lifestyle. The stronger one’s immune system is, the better it can build up defenses against germs or other pathogens. This prevents infectious diseases and shortens the healing process. With a healthy and varied diet, the organism has sufficient nutrients and messenger substances that are important for recovery. At the same time, physical overexertion or being overweight should be avoided. Intensive sports activities or carrying heavy objects increase the strain on the heart. On the other hand, regular breaks, rest periods and relaxation exercises are helpful. Meditation or [[yoga]] can bring about improvement during recovery. In times of a strong emotional challenge or a lot of stress, the affected person should pay attention to ways to reduce stress. Various coping mechanisms, changing cognitive attitudes, or learning new behavior patterns help to better deal with stressful situations. In a respectful interaction with other people, one’s own limits can be pointed out or emerging conflicts can be clarified with calmness and level-headedness. In all activities, the relief of one’s own heart should be the focus. This is to be implemented on the physical as well as the emotional level, so that no additional burdens arise.
