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Acute Coronary Syndrome (ACS)

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

Article printed on page 30 in the May 12, 2010 issue of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

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 have some degree of build up of plaque in our arteries. These areas covered in plaque 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".

I cannot stress enough on how important it is to get to an emergency department when severe, unexpected chest pain occurs. We are fortunate to have a world class cardiac center at the Trillium Hospital. 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 deprivation. 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.

Related resources:

Acute coronary syndrome from Wikipedia, the free encyclopedia.

Acute Coronary Syndrome from American Heart Association.

Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) from Merck Manuals Online Medical Library. "Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or heart attack (myocardial infarction) depending on the location and amount of blockage."

Myocardial infarction from Wikipedia, the free encyclopedia. "Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing heart cells to die." Illustrated.

Heart Attack (Myocardial Infarction) from MedicineNet.

Heart Disease - Slideshow. 22 slides from MedicineNet.

Myocardial Ischemia from MayoClinic. "Insufficient blood supply to the myocardium can result in myocardial ischemia, injury or infarction, or all three. Atherosclerosis of the larger coronary arteries is the most common anatomic condition to diminish coronary blood flow."

Myocardial infarction from Schools Wikipedia. Illustrated. "A heart attack, known in medicine as an (acute) myocardial infarction (AMI or MI), occurs when the blood supply to part of the heart is interrupted. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque ... Classical symptoms of acute myocardial infarction include sudden chest pain (typically radiating to the left arm or left side of the neck), shortness of breath, nausea, vomiting, palpitations, sweating, and anxiety (often described as a sense of impending doom)." Risk factors. Pathophysiology. Triggers. Classification. Symptoms. Diagnosis. First aid. Treatment. Complications. Prognosis. Legal implications.

Myocardial Infarction by Drew Evan Fenton, MD, WebMD. Diagnosis. Treatment and Medication. Symptoms. Causes. Risk factors. "MI is a leading cause of morbidity and mortality in the United States. Approximately 1.3 million cases of nonfatal MI are reported each year, for an annual incidence rate of approximately 600 cases per 100,000 people ... Cardiovascular diseases account for 12 million deaths annually worldwide ... Approximately 500,000-700,000 deaths are caused by ischemic heart disease annually in the United States ... MI most frequently occurs in persons older than 45 years."

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