Acute Coronary Syndrome

Lake Louise. (Dr. Noorali Bharwani)
Lake Louise. (Dr. Noorali Bharwani)

Acute coronary syndrome is a medical emergency.

Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. Part of the heart muscle is unable to function properly or dies. It is critical to make an early diagnosis.

The problem is, not all chest pain patients get investigated because the presentation of symptoms can be short term, intermittent or not very clear. Just like not all patients with headache get a CT scan of the head. Because not every person with a headache has a brain tumour. That is why many brain tumours are diagnosed late.

“Diagnosing a patient presenting with chest discomfort or pain remains a challenge for physicians despite advances in diagnostic testing, clinical practice guidelines, and enhanced understanding of acute coronary syndrome (ACS),” says the Canadian Medical Protective Association (CMPA) in their newsletter (December 2019).

CMPA suggests appropriate triage and testing, as guided by symptoms and patient risk factors. This may help improve the timely diagnosis of ACS. Basically, no chest pain should be ignored irrespective of age or sex of the patient.

What is acute coronary syndrome?

Acute Coronary Syndrome is a name given to three types of coronary artery diseases that are associated with sudden rupture of plaque inside the coronary artery. One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue. Angina and heart attacks are types of acute coronary syndrome.

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

Chest pain or discomfort is the most common symptom. However, in some patients’ signs and symptoms may vary significantly depending on patient’s age, sex and other medical conditions.

If you are a woman, older adult or have diabetes then you are more likely to have signs and symptoms without chest pain or discomfort. That is one of the reasons why a correct diagnosis is missed.

CMPA says, “Consistent with the medical literature, risk factors for women also displayed gender-specific characteristics, such as menopause and pregnancy, and women frequently presented with atypical chest pain.”

The signs and symptoms of ACS usually begin abruptly. They include: Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning. Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw.

Early diagnosis is important. When someone is rushed to the emergency room with chest pain, testing must be performed to determine whether or not a person’s signs and symptoms are due to a heart attack or to another cause. The doctor will order a blood test to see if there is evidence that heart cells are dying and order ECG to check for the heart’s electrical activity.

Initially, if the tests are normal then serial testing (ECG and cardiac enzymes) should be done to check for any changes. Mistakes occur if there is failure to consider cardiac risk factors in the diagnosis of unexplained chest discomfort or pain. Especially in female patients.

In conclusion, managing acute coronary syndrome is a relatively common and challenging task, says CMPA. Patient’s risk factors should be considered along with appropriate serial blood testing in the emergency department. This can contribute to safer patient care, says CMPA.

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