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Coronary Heart Disease - CHD

Acute Coronary Syndrome - ACS

Coronary artery disease (CAD) produces two broad categories of clinical syndromes - stable angina, and ACS. If you have CAD, you probably know all about stable angina. But chances are, you don't know much about ACS. You need to know about ACS, though, because it is extremely important.

What is ACS?

ASC occurs when a blood clot suddenly forms within a coronary artery, usually due to the acute rupture of a plaque. Plaque rupture can occur at any time, and often completely without warning. The blood clot will often completely stop or significantly reduce the flow of blood to the heart muscle, and is considered a medical emergency. Any plaque can rupture, even small ones. This is why you will often hear of people who have a myocardial infarction (MI), or heart attack, shortly after being told their CAD is "insignificant."

Symptoms of ACS

The symptoms of ACS are similar to those of stable angina (i.e., chest pain or discomfort), but are often much more intense and persistent. The chest pain in ACS is often accompanied by other disturbing symptoms such as sweating, dizziness, nausea, extreme anxiety, and what is often described as a "feeling of impending doom." The chest pain is often untouched by nitroglycerin (which usually relieves stable angina). On the other hand, some people who have ACS will have only mild symptoms, or will fail to notice any symptoms at all - at least initially. Unfortunately, the permanent heart damage that often results from ACS will, sooner or later, produce symptoms.

The Three General Types of ACS

Cardiologists divide ACS into three distinct clinical patterns. Two of them represent different forms of MI, and one represents a particularly severe form of angina, called "unstable angina." All three are caused by acute blood clots in the coronary arteries.

1.

STEMI - ST-Elevation Myocardial Infarction, so named because the "ST segment on the ECG appears "elevated". This occurs when a coronary artery is completely blocked, so that a large proportion of the heart muscle being supplied by that artery is becoming damaged.

2.

NSTEMI - Non-ST-Elevation Myocardial infarction, in which the "ST segment" is not elevated. This occurs when the blockage in the coronary artery is not complete, so that a relatively small proportion of heart muscle is becoming damaged

3.

Unstable Angina When an ACS occurs that does not actually cause heart muscle to die. the blood clot that occurs in ACS does not cause any permanent heart muscle damage, either because the degree of blockage it produces is not large enough, or because the clot doesn't persist long enough, to produce cell death.


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