70 North Country Road, Suite 205
Port Jefferson, NY 11777
HVMS@matherhospital.org

Acute Coronary Syndrome

Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One condition under the umbrella of acute coronary syndrome is myocardial infarction (heart attack) — when cell death results in damaged or destroyed heart tissue. Even when acute coronary syndrome causes no cell death, the reduced blood flow alters heart function and indicates a high risk of heart attack.

Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. Treatment goals include improving blood flow, treating complications and preventing future problems.

Diagram Blood Flow through the Heart

Symptoms
The signs and symptoms of acute coronary syndrome, which usually begin abruptly, include the following:

  • Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning
  • Pain radiating from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
  • Nausea or vomiting
  • Indigestion
  • Shortness of breath (dyspnea)
  • Sudden, heavy sweating (diaphoresis)
  • Lightheadedness, dizziness or fainting
  • Unusual or unexplained fatigue
  • Feeling restless or apprehensive

While chest pain or discomfort is the most common symptom associated with acute coronary syndrome, signs and symptoms may vary significantly depending on your age, sex and other medical conditions. People who are more likely to have signs and symptoms without chest pain or discomfort are women, older adults and people with diabetes.

Causes
Acute coronary syndrome usually results from the buildup of fatty deposits (plaques) in and on the walls of coronary arteries, the blood vessels delivering oxygen and nutrients to heart muscles.

When a plaque deposit ruptures or splits, a blood clot forms. This clot obstructs the flow of blood to heart muscles.

When the supply of oxygen to cells is too low, cells of the heart muscles can die. The death of cells — resulting in damage to muscle tissues — is a heart attack (myocardial infarction).

Even when there is no cell death, an inadequate supply of oxygen still results in heart muscles that don't work correctly or efficiently. This dysfunction may be temporary or permanent. When acute coronary syndrome doesn't result in cell death, it is called unstable angina.

Risk factors
The risk factors for acute coronary syndrome are the same as those for other types of heart disease. Acute coronary syndrome risk factors include:

  • Older age (older than 45 for men and older than 55 for women)
  • High blood pressure
  • High blood cholesterol
  • Cigarette smoking
  • Lack of physical activity
  • Unhealthy diet
  • Obesity or overweight
  • Diabetes
  • Family history of chest pain, heart disease or stroke
  • For women, a history of high blood pressure, preeclampsia or diabetes during pregnancy

If you have signs or symptoms associated with acute coronary syndrome, our doctors will likely order several tests.

Electrocardiogram (ECG). This test measures electrical activity in your heart via electrodes attached to your skin. Abnormal or irregular impulses can indicate poor heart function due to a lack of oxygen to the heart. Certain patterns in electrical signals may indicate the general location of a blockage. The test may be repeated several times.

Blood tests. Certain enzymes may be detected in the blood if cell death has resulted in damage to heart tissue. A positive result indicates a heart attack.

The information from these two tests — as well as signs and symptoms — may provide the primary basis for a diagnosis of acute coronary syndrome and may determine whether the condition can be classified as a heart attack or unstable angina.

Other tests may be ordered to characterize the condition more thoroughly, rule out other causes of symptoms, or combine diagnostic and treatment interventions.

Coronary angiogram. This procedure uses X-ray imaging to see your heart's blood vessels. A long, tiny tube (catheter) is threaded through an artery, usually in your arm or groin, to the arteries in your heart. A liquid dye, which can be detected by X-rays, is sent through the tube to your arteries. Multiple X-ray images of your heart can reveal blockage or narrowing of the arteries. The catheter may also be used for treatments.

Echocardiogram. An echocardiogram uses sound waves, directed at your heart from a wand-like device, to produce a live image of your heart. An echocardiogram can help determine whether the heart is pumping correctly.

Myocardial perfusion imaging (MPI). This test shows how well blood flows through your heart muscle. A tiny, safe amount of radioactive substance is injected into your blood. A specialized camera detects the blood as it moves through your heart to reveal whether enough blood is flowing through heart muscles and where blood flow is reduced.

Computerized tomography (CT) angiogram. A CT angiogram uses a specialized X-ray technology that can produce multiple images — cross-sectional 2-D slices — of your heart. These images can detect narrowed or blocked coronary arteries.

Stress test. A stress test assesses how well your heart functions when you exercise — when your heart needs to work harder. In some cases, you may receive a medication to increase your heart rate rather than exercising. This test is only done when there is no evidence of acute coronary syndrome or another life-threatening heart condition when you are at rest. During the stress test, heart function may be assessed by an ECG, echocardiogram or myocardial perfusion imaging.

We encourage you to meet our staff and discover the full range of our cardiovascular medical services.
Please feel free to contact us at our main office in East Setauket, NY, with any questions you might have.

Medical note: The content on this website is informational only to describe Three Village Cardiology's recognized cardiovascular sub-specialties. If you feel you are in need of medical help — call 911 or get immediate emergency services to get a prompt diagnosis and appropriate care. Do not drive yourself to an emergency department.



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