Adequate Coronary Syndrome (ACS)

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ACUTE CORONARY SYNDROME
The term acute coronary syndrome (ACS) is a sort of umbrella term that is used to define symptoms and signs of myocardial ischemia. This ischemia includes unstable angina and non-STEMI, where arteries are only partially occluded and STEMI, where arteries are completely occluded. The acute coronary syndrome can present in a patient for the first time or in a patient with a history of stable angina. The underlying pathology for both unstable angina and MI is usually rupture of an atherosclerotic plaque which then causes thrombus formation and subsequent inflammation. [2][3]
The risk factors for coronary artery disease, which often results in acute coronary syndrome include modifiable and non-modifiable risks. Non-modifiable …show more content…
These conditions present similarly but there are a few important differences. Unstable angina is due to a thrombus that partially or intermittently occludes the vessel. The clinical presentation is one of chest pain that may or may not radiate. Patients can present with dyspnea, diaphoresis, pre-syncope, palpitations, tachycardia, tachypnea, changes in blood pressure, decreased saturation and rhythm abnormalities. [1][2][6] These symptoms occur at rest or with exertion and limit activity. Diagnostic findings include ST depression or T-wave inversion on ECG. Cardiac biomarkers are NOT elevated. NSTEMI is caused by a similar event as unstable angina and presents in a similar way, the only difference being that the duration of pain is longer and the pain is more severe. Diagnostic finding are similar on ECG but cardiac biomarkers are elevated. STEMI in comparison is caused by a thrombus that fully occludes the vessel. Clinical presentation is similar to NSTEMI. ECG findings include ST elevation or a new left bundle branch block. Cardiac biomarkers are raised in …show more content…
In ST-segment elevated ACS however immediate reperfusion restores artery patency, preserves left ventricular function and improves the rate of survival. Successful therapy is usually indicated by the resolution of pain. Primary percutaneous coronary intervention (PCI) is the treatment of choice in ST-segment elevated MI and works best when used in combination with a glycoprotein IIb/IIIa receptor antagonist and intracoronary stent implantation [1][6]. When compared to thrombolysis it reduces the risk of death, recurrent MI or stroke to a greater extent. However in many settings in South Africa access to PCI within 90 minutes is not possible. Therefore thrombolysis becomes a very important aspect of treatment. When a patient is thrombolized properly, it can reduce hospital mortality by 25-50% [1]. Patients who benefit most from this therapy are those was receive treatment within the first few hours of onset. Examples include a newer drug, Alteplase and the older but still highly effective streptokinase. Both of these however come with their own side effects and risks the major common one however being bleeding. When thrombolysis is received within 12 hours and especially when received within 6 hours mortality is reduced as well as ECG changes
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