Acute coronary syndrome (ACS)

Acute Coronary Artery Disease (CAD), also known as acute myocardial infarction, is a condition in which the coronary arteries, responsible for supplying blood to the heart, become narrowed or blocked. This leads to reduced blood flow to the heart muscle, resulting in ischemia. Patients may experience chest pain, arrhythmias, or even sudden death

Causes of Coronary Artery Blockage

Coronary artery blockage, which restricts blood flow to the heart, occurs due to the narrowing of the arteries caused by age-related changes. Fat and calcium deposits accumulate on the inner walls of these arteries, making them rigid and thickened, which reduces flexibility. Consequently, the coronary arteries become narrowed or blocked, leading to insufficient blood flow to the heart. This can result in reduced oxygen supply or even death of heart muscle tissue.

Symptoms of Coronary Artery Blockage

The primary symptom of coronary artery blockage is angina pectoris, which can be categorized into two types: stable angina and unstable angina.

Stable Angina:

This type of chest pain typically occurs during physical exertion, such as walking uphill, running, or during episodes of anger or stress. The pain usually subsides when the activity is stopped or the person relaxes. The duration of pain is usually between 3 to 5 minutes but may last up to 20 minutes. It is often described as a feeling of tightness or heaviness in the chest and may radiate to the jaw or left arm. Other symptoms can include palpitations, shortness of breath, dizziness, nausea, and a sense of impending doom. The pain occurs because the heart demands more blood and oxygen during exertion or emotional stress, but the narrowed coronary arteries cannot supply enough to meet this demand. However, when the person rests, the pain subsides without permanent damage to the heart muscle.

Unstable Angina:

Unstable angina refers to chest pain that occurs at rest or with minimal exertion and is not directly related to physical activity. This type of pain often lasts longer than 20 minutes and may be accompanied by symptoms like shock and heart failure. It indicates partial blockage of a coronary artery and may lead to a myocardial infarction (heart attack). Additional symptoms include palpitations, dizziness, blurred vision, nausea, vomiting, and signs of heart failure such as fatigue, shortness of breath, or signs of shock like sweating, cold extremities, and loss of consciousness.

Risk Factors for Coronary Artery Disease

• Age: The risk increases with age, especially for men over 45 and women over 50.
• Sedentary Lifestyle: Lack of physical activity, often seen in desk jobs, contributes to fat buildup in blood vessels.
• Underlying Conditions: Diseases like high cholesterol, high blood pressure, diabetes, and obesity increase the risk of coronary artery disease.
• Smoking: A major risk factor.
• Family History: A family history of coronary artery disease also increases the risk.

Diagnosis of Coronary Artery Disease

Doctors diagnose coronary artery disease through:

1. Initial Assessment: Evaluating chest pain characteristics (location, duration) and symptoms. Medical history and vital signs, including heart rate and blood pressure, are also considered.
2. Blood Tests: Help determine the severity of coronary artery disease and identify contributing factors such as diabetes, high blood pressure, and cholesterol levels.
3. Electrocardiography (ECG): Assesses heart rhythm and detects ischemia or myocardial infarction. Abnormal ECG waves may indicate severe disease, but a normal result does not rule out the condition.
4. Exercise Stress Test: Evaluates heart function during physical activity to detect chest discomfort or ECG changes related to coronary artery narrowing.
5. Coronary Angiography: A contrast dye is injected to visualize the narrowed areas of coronary arteries using X-rays.
6. Echocardiography: Uses sound waves to examine the structure and function of the heart.

Treatment Options for Coronary Artery Disease

Treatment depends on symptoms, severity, age, and other medical conditions:

1. Medication Therapy: To alleviate symptoms, including antiplatelet medications, vasodilators, diuretics, and medications for comorbidities like hypertension, diabetes, and cholesterol.
2. Patient Management During Treatment:

• Carry prescribed sublingual medication at all times for chest pain relief.
• Seek immediate medical help if chest pain persists after medication or worsens.
• Adhere to prescribed medications without self-adjusting dosage.
• Lifestyle changes such as a healthy diet, regular exercise, stress management, and avoiding smoking, alcohol, and caffeine are crucial.
• Regular follow-up appointments with a healthcare provider.

1. Percutaneous Transluminal Coronary Angioplasty (PTCA):

• A procedure to dilate narrowed coronary arteries using a balloon or stent.
• Suitable for severe narrowing that doesn’t respond to medication.
• Involves inserting a catheter with a deflated balloon through a blood vessel to the narrowed artery. The balloon is inflated to compress the plaque, improving blood flow. A stent may be placed to prevent re-narrowing.

Cardiac Care at Phyathai Sriracha Hospital

At the Cardiac Center of Phyathai Sriracha Hospital, experienced cardiologists provide specialized care for heart and coronary artery diseases. Comprehensive diagnostic and treatment services are available 24/7, with an average door-to-balloon time of 35 minutes. This ensures that patients with coronary artery disease receive timely care within the critical 90-minute window, improving their chances of survival. Medical staff continue monitoring and caring for patients until stabilization is achieved.