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How Does Acute Coronary Syndrome
Differ from Angina?

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

This article originally appeared on page 20 in the July 31-August 1, 2004 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.

Acute Coronary Syndrome is a relatively new term being bantered around emergency departments. It is quite different from Angina, which refers to the pain associated with constriction of the blood vessels around the heart. Angina usually responds to nitroglycerin which dilates the arteries and reverses the problem. Acute Coronary Syndrome refers to the constellation of symptoms associated with a disruption of an atherosclerotic plaque within the vessels of the heart. Most of us in North America do have some degree of build up of plaque in our arteries. These areas covered in plaques can spontaneously rupture and flow downstream to cause trouble, when they lodge in narrow areas and block flow. This in turn impairs blood flow, which impairs oxygenation of the surrounding tissue and leads to cell damage or death. This in a nutshell is a myocardial infarction or "heart attack".

My local cardiologist, Dr. Manish Maingi, stresses how important it is to get to an emergency department when severe unexpected chest pain occurs. Minutes count, and the outcome is often a factor of how quickly the diagnosis is made, and treatment begun. A definitive diagnosis can only be made in the emergency department with access to laboratory testing and the use of 12 and 15-lead EKGs. The second part of the reader's question revolves around transportation. Recently, debate has surfaced as to whether call 911 or drive when minutes count, and the patient appears stable. We are fortunate in Mississauga in that hospitals are only minutes away, yet there have been isolated instances where delays in transport have resulted in adverse consequences. I can never recommend that anyone with chest pains be behind the wheel of a car, nor can I endorse driving long distances.

The full 12-lead EKG can pick up the first signs of heart muscle damage occurring as a result of oxygen starvation. Heart muscle is made of special fibers. When damaged, the muscle fibers liberate unique enzymes and proteins into the blood. These substances can be detected in the blood. Troponin I and T are specific to heart muscle. Creatine kinase is another enzyme that has sub-types specific to the heart. It may take a few repeat blood samples to decide whether levels are present or rising. Even so, the diagnosis of Acute Coronary Syndrome still relies on the clinical judgment of a physician. It is a mixture of science, experience and instinct.

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