Acute coronary syndrome: what is it?
Acute coronary syndrome (ACS) is a term that describes the syndrome of coronary insufficiency, in which stops (or severely limited) the blood supply of the myocardium. When the blood enters the heart, the myocardium develops damage.
What is it – OKS?
The term «acute coronary syndrome» is used by doctors to describe certain heart diseases, including myocardial infarction and unstable angina. Such an Association of these diseases is justified by the fact that the basis of their development are the same reason is a sharp reduction or cessation of blood supply to part of the myocardium. On the basis of ECG OAKS are divided into two groups:
- ACS with ST-segment elevation.
- ACS without ST-segment elevation.
This separation is important so that the algorythm of emergency aid in each of these types of ACS are different.
The causes of OAKS
Most cases of ACS are caused by narrowing of the coronary arteries that supply blood to the heart. The most common cause of this narrowing are atherosclerotic plaques in the lining of blood vessels, which are formed for many years in one or many areas of the arteries. Other causes of ACS are less common. These include:
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- Inflammation of the coronary arteries.
- Stab wounds of the heart.
- Blood clots elsewhere in the body (e.g., in the chamber of the heart) and moves it to the coronary artery.
- The use of cocaine can cause a spasm of the coronary arteries.
- Complications of heart surgery.
- Some other rare heart disease.
Risk factors for development of ACS
OKS – is a common problem. The majority of the cases the pathology develops in people older than 50 years, the frequency increases with increasing age. Other risk factors include:
- High blood pressure.
- Elevated cholesterol levels.
- Physical inactivity.
- Unhealthy diet.
- Having relatives with heart disease or stroke.
The symptoms of ACS
The most common symptom of ACS is presence of severe pain in the chest. Pain syndrome can be felt as pressure in the chest. The pain can also spread to the jaw, left arm, back, or stomach. People with ACS also may sweat, be restless, suffer from General weakness, nausea and shortness of breath. Remember that every person with symptoms of ACS the essential medical emergency.
The diagnosis of ACS
Sometimes doctors are hard to distinguish OAKS from other diseases of the heart, which can also cause pain in the chest. Every patient with a clinical picture of ACS should be hospitalized. After admission to a medical institution conducts the following examinations:
- Electrocardiography, which is the main method of diagnosis of ACS. It is determined by the type of ACS and further treatment.
- Blood tests that determine the level of substances that increase when the death of the cardiomyocytes. The definition of these substances (troponin, kreatininfosfokinaza) allows to distinguish between unstable angina and myocardial infarction.
- Echocardiography, which revealed violations of the contractility of the heart muscle.
To determine General health, and conducted other surveys of General and biochemical blood analysis, radiography of the chest cavity.
The treatment of acute coronary syndrome
First aid to the patient with suspected ACS is at home. Before the arrival of the ambulance may:
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- To ensure patient rest and fresh air.
- To give to the patient to chew Aspirin.
The choice of treatment of ACS depends on its type:
- The goal of treatment of ACS with ST elevation aimed at the rapid restoration of blood flow in the injured region of the heart, which can be achieved with the help of medicines or surgical operations.
- The treatment of ACS without ST elevation is more conservative.
Depending on the diagnosis and type of AUX can be assigned the following drugs:
- Thrombolytics (Streptokinase, Alteplase, Tenecteplase), which help to break down the blood clot blocking the coronary artery lumen.
- Nitrates (Nitroglycerin), which temporarily expand blood vessels and improve blood flow to the myocardium.
- Antiplatelet drugs (Aspirin, plavix, Brilinta), which prevent the formation of blood clots by affecting platelet function.
- Anticoagulants (Heparin, enoxaparin) that affect the plasma component of blood clotting.
- Beta-blockers (Metoprolol, Carvedilol, Bisoprolol), which helps to relax the heart muscle and slow the heart rate, reducing his need for oxygen and lowering blood pressure.
- Angiospermae inhibitors of the enzyme (Ramipril, Perindopril) or blockers of receptors of angiotensin (Losartan, Irbesartan), which expand arteries, lower blood pressure and reduce the workload on the heart.
- Statins (Atorvastatin, Rosuvastatin), which reduce blood cholesterol and stabilize atherosclerotic plaque.
Patients with ACS often requires surgical intervention aimed at restoring the patency of the coronary arteries. These operations include:
- Angioplasty and stenting. In this surgery performed by the doctor to the place of narrowing of the coronary artery with a thin catheter, then inflated the balloon expands the lumen. To preserve the open lumen of the artery is sometimes performed stenting of the narrowed area is the implantation of special intravascular prosthesis (stent).
- Coronary artery bypass. In this surgery, surgeons replace the diseased artery shunts – a vessel from another location in the body of the patient.