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Today in Health & Wellness

Acute Coronary Syndrome

Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Home Remedies
Doctors to Consult

Acute Coronary Syndrome or ACS is an umbrella term for conditions that bring sudden and reduced blood flow to the heart (e.g. Unstable angina, non ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction).

ACS is most often caused by acute thrombosis where the surface of the atherosclerotic plaques (made up of fatty deposits) that have built up in the arteries bursts and forms a clot that restricts blood flow to the heart

Other etiology of ACS include progressive mechanical obstruction, inflammation, secondary unstable angina (e.g., due to severe anemia or hyperthyroidism), and dynamic obstruction (coronary vasoconstriction)

  • Chest pain or discomfort (may be described as a feeling of tightness, burning, fullness, or heaviness)
  • Pain or discomfort in arms, jaw, neck, back or stomach
  • Dyspnea or shortness of breath
  • Feeling dizzy or lightheaded
  • Nausea
  • Vomiting
  • Diaphoresis or sudden heavy sweating
Risk Factors
  • Age ( > 45 y.o. for men, > 55 y.o. for women)
  • Cigarette smoking
  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Sedentary lifestyle
  • Being overweight or obese
  • A family history of chest pain, heart disease or stroke
  • High-fat, low-antioxidant diets
Commonly Prescribed Drugs

Initial Management

  1. Initial drug therapy involves MONA (Morphine, Oxygen, Nitrates and Aspirin):
    • Aspirin 300 mg orally (unless contraindicated)
    • Oxygen 15 L per minute by mask
    • Analgesia IV aliquots of morphine 2.5 mg as required
    • Glyceryl-trinitrate sublingual or IV as required

  2. ECG within 5 minutes of arrival

Adjunct drug therapy

  • Beta blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Anti-platelet agents
  • Anti-thrombin agents
Treatment and Management


Detects presence of biomarkers that leak in the blood when the heart is damaged by a heart attack. Other blood tests may be recommended:

Records the electrical activity of the heart

  • Physical examination
    • Chest examination, auscultation, and measurement of heart rate and blood pressure
  • Blood test for cardiac biomarkers
    • Full blood examination (FBE)
    • Electrolytes (esp. potassium)
    • Serum lipids within 24 hours
    • Blood glucose
  • Electrocardiogram (ECG or EKG)
  • Additional diagnostic tests include:
    • Echocardiogram
    • Chest X-ray
    • Nuclear scan
    • Computerized tomography (CT) angiogram
    • Coronary angiogram (cardiac catheterization)
    • Exercise stress test

Surgery and other procedures

  • Angioplasty (involves inflating a small balloon to open the artery) and stenting (a mesh tube is left in the artery to keep it open)
  • Coronary bypass surgery


Home Remedies

Lifestyle Recommendations

  • Don't smoke
  • Eat a heart-healthy diet
  • Adapt active lifestyle
  • Monitor cholesterol levels regularly
  • Control blood pressure
  • Maintain a healthy weight
  • Manage stress
  • Drink alcohol in moderation
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