Definition and Natural History of Acute Coronary Syndromes

Acute Coronary Syndromes (ACS) encompass a spectrum of conditions associated with sudden, reduced blood flow to the heart. The primary forms include unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).

Pathophysiology of ACS

ACS is commonly caused by the rupture of an atherosclerotic plaque within a coronary artery, leading to partial or complete occlusion of blood flow. Platelet aggregation and thrombus formation further exacerbate myocardial ischemia.

Clinical Presentation

• Chest pain (often radiating to the left arm or jaw)
• Dyspnea and diaphoresis
• Nausea or syncope in severe cases

Management Approaches and Therapeutic Interventions

Initial Assessment and Diagnosis

Diagnosis is made through clinical evaluation, electrocardiography (ECG), and cardiac biomarkers like troponins.

Pharmacological Treatment

• Antiplatelet therapy (Aspirin, P2Y12 inhibitors)
• Anticoagulants (Heparin, direct thrombin inhibitors)
• Beta-blockers for myocardial protection
• Statins for lipid management

Interventional Strategies

Revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is crucial in STEMI patients.

Long-Term Management

• Lifestyle modification (diet, exercise, smoking cessation)
• Secondary prevention with medication adherence