Acute coronary syndrome, or ACS, occurs when blood flow to the heart is drastically reduced. In most cases, it’s caused by the rupture of an atheromatous plaque in the coronary arteries.
Atheromatous plaques are abnormal accumulations of materials in blood vessels. The detachment of a fragment of said atheroma triggers thrombus formation. Then, total or partial blockage of a coronary artery occurs.
The coronary arteries are the main blood vessels that supply the heart. Therefore, obstruction results in decreased blood blow to the heart. This leads to ischemic cardiopathology.
This is the main cause of ACS. However, some other things can lead to it as well.
These may include the following:
- Kawasaki disease
- Rheumatoid arthritis
- Coronary thrombosis
- Hypercoagulable states
- Arterial embolisms
- Spontaneous coronary artery dissection
- Congenital anomalies
Clinical Manifestations of ACS
The main symptom of ACS is chest pain that manifests around the sternum or stomach. In addition, this pain may spread to areas such as the shoulders, neck, or jaw.
The pain is sudden and becomes more intense as time goes on. Typically, it reaches its peak approximately after two to five minutes. However, the episodes may be intermittent sometimes.
However, in young patients between the ages of 25 and 40 and in elderly patients over 75, the clinical picture may be atypical and unspecific. That said, it may manifest as epigastric pain, feeling of indigestion, fatigue, or syncope.
Diagnosis of Acute Coronary Syndrome
Typically, doctors diagnosis ACS after a patient experiences chest pain with suspected ischemia. In these cases, the doctor will run some additional tests to determine its presence and severity.
Next, we’ll take a look at these tests.
Overall, an electrocardiogram test is the diagnostic test of choice for cardiac problems.
This is a medical test that records the heart’s electrical activity in each heartbeat. The, it uses a graphical representation to show the electrical stimulation of the atria and ventricles (the movement of the heart).
In case of suspicion, a doctor should perform an electrocardiogram within the first ten minutes of assessment. If the results are inconclusive but clinical evidence still exists, experts recommend that doctors repeat the electrocardiogram every 15 to 30 minutes to continue the evaluation.
In addition, blood samples allow doctors to analyze cardiac enzymes that indicate the presence of myocardial necrosis. If the markers of myocardial necrosis – troponins and creatine kinase-MB mass – are high, the medical professional should suspect myocardial infarction.
Specialists recommend that doctors analyze these markers during the initial 60 minutes.
However, the absence of these markers during an initial analysis doesn’t rule out myocardial damage. Therefore, doctors should repeat the test six and twelve hours after the manifestation of chest pain.
Finally, echocardiograms, or heart sonograms, allow medical professionals to study the heart in more detail.
The echocardiogram is a very popular medical test. This is because it obtains moving images of the heart. Thus, it can evaluate the status of the heart’s chambers and their movements to confirm or rule out ischemia.
In addition, it also evaluates heart size and strength and the condition of the walls of the heart’s chambers. Overall, it’s a non-invasive test that involves no risk to the patient. This is because it uses ultrasound to obtain heart images.
If the doctor uses this test, the absence of movement disturbances in the heart wall rule out the presence of ischemia. After all, the existence of movement disturbances isn’t unique to acute coronary syndrome. For that reason, the test results and symptoms should be jointly assessed.
Other Tests for ACS
Sometimes, doctors may recommend a coronary angiography. This is a test that uses a contrast agent and X-rays to observe how blood flows through the heart.
In addition, doctors can run other tests to diagnose the patient. Overall, these include a cardiac stress test, radionuclide cardiac stress testing, and an exercise stress echocardiogram.
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