Acute Coronary Syndrome (ACS)

The most common symptom of ACS is chest pain. The chest pain may come on quickly, come and go, or get worse with exercise or rest.

Other possible symptoms include:

• Pain in the shoulder, arm, neck, jaw, back or abdomen
• Discomfort that feels like tightness, squeezing, crushing, burning, choking or aching
• Discomfort that occurs at rest and does not easily subside with medication
• Shortness of breath
• Anxiety
• Nausea or vomiting
• Sweating
• Dizziness or lightheadedness
• Rapid or irregular heartbeat

While chest pain is common in ACS, women and the elderly may more frequently experience these additional symptoms.

An ACS is a medical emergency. If you have symptoms, call 911 immediately.

• Do not try to drive yourself to the hospital.
• Do not wait – if you are having a heart attack, you are at greatest risk for sudden death in the early hours. 

Plaque, a fatty substance composed of cholesterol, fat, cells, and other materials, can accumulate in the arteries that supply oxygen-rich blood to your heart. The buildup of plaque can obstruct blood flow in two primary ways:

• Gradually, as the plaque builds up, it can narrow the artery to the point where it restricts blood flow, leading to symptoms.
• Alternatively, the plaque can suddenly rupture, triggering the formation of a blood clot that rapidly and severely narrows or blocks the artery.

Various risk factors for heart disease can contribute to the development of ACS.

Possible Complications – in some cases, ACS can lead to other health problems including:

• Abnormal heart rhythms
• Death
• Heart attack
• Heart failure, which happens when the heart cannot pump enough blood
• Rupture of part of the heart muscle causing life-threatening problems
• Stroke 

Your health care provider will do an exam, listen to your chest with a stethoscope and inquire about your medical history. Tests used to diagnose ACS include:

• Electrocardiogram (ECG) – An ECG is typically the first test your doctor will perform. It measures your heart's electrical activity using small pads taped to your chest and other areas of your body.
• Blood tests – Certain blood tests help determine the cause of chest pain and assess your risk of a heart attack. A troponin blood test can indicate if your heart cells have been damaged and confirm if you’re having a heart attack.
• Echocardiogram – This test uses sound waves to look provide a detailed view of your heart helping to identify any damage and detect certain heart conditions.
• Coronary Angiography – This test may be performed immediately or once you’re more stable. It involves injecting a special dye into the heart’s arteries through small catheters and using X-rays to visualize blood flow and detect any blockages or narrowing. The results can guide your provider in deciding the next steps in your treatment.
• While in the hospital, you may undergo additional tests to evaluate your heart, including:
  • Exercise stress test
  • Nuclear stress test
  • Stress echocardiography 

There is a lot you can do to help prevent ACS.

• Eat a heart-healthy diet. Have plenty of fruits, veggies, whole grains and lean meats. Try to limit foods high in cholesterol and saturated fats, since too much of these substances can clog your arteries.
• Get exercise. Aim to get at least 30 minutes of moderate exercise most days of the week.
• Lose weight if you are overweight.
• Quit smoking. Smoking can damage your heart. Ask your doctor if you need help quitting.
• Get preventive health screenings. You should see your doctor for regular cholesterol and blood pressure tests, and to learn how to keep your numbers in check.
• Manage health conditions, such as high blood pressure, high cholesterol or diabetes. 
   

How well you do after an ACS depends on:

• How quickly you get treated
• The number and severity of blocked arteries  
• Whether your heart has been damaged, as well as the extent and location of the damage

Generally, the sooner the blocked artery is reopened, the less damage your heart will sustain.  Outcomes tend to be best when the artery is unblocked within a few hours of the onset of symptoms.