Acute coronary syndrome (ACS)

Acute coronary syndrome (ACS) is a term used to describe a range of conditions that result from the sudden reduction or blockage of blood flow to the heart muscle. It is a medical emergency that requires prompt diagnosis and treatment to prevent further damage to the heart muscle.

Case: John is a 60-year-old man who presented to the emergency department with severe chest pain that had started about an hour ago. He had a history of high blood pressure and high cholesterol levels. On examination, he had elevated blood pressure and a rapid heart rate. An electrocardiogram (ECG) showed signs of ST-segment elevation, indicating a heart attack.


ACS typically results from the formation of a blood clot within a coronary artery that supplies blood to the heart muscle. The blood clot partially or completely blocks blood flow, leading to ischemia (a lack of oxygen) and damage to the heart muscle. ACS can be classified into three types: unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Unstable angina is caused by a partial blockage of a coronary artery, while NSTEMI and STEMI result from a complete blockage of a coronary artery.

Signs and symptoms

The hallmark symptom of ACS is chest pain, which may feel like pressure, tightness, or a squeezing sensation in the chest. Other symptoms may include shortness of breath, nausea, sweating, lightheadedness, and pain or discomfort in the arms, back, neck, or jaw.


The diagnosis of ACS is based on a combination of clinical presentation, ECG findings, and blood tests. An ECG can help identify the type of ACS and the extent of the damage to the heart muscle. Blood tests, such as troponin, are used to confirm the diagnosis and assess the extent of heart muscle damage.


The treatment of ACS aims to restore blood flow to the heart muscle as quickly as possible. Depending on the type and severity of ACS, treatment may include medications, invasive procedures, or both. Medications may include aspirin, nitroglycerin, beta-blockers, and antiplatelet agents. Invasive procedures may include angioplasty, stent placement, or coronary artery bypass surgery.

Dos and don’ts

  • Do seek prompt medical attention if you experience symptoms of ACS.
  • Don’t ignore chest pain or discomfort, even if it goes away quickly.
  • Do take medications as prescribed by your doctor.
  • Don’t smoke or use tobacco products, as they can increase the risk of ACS.
  • Do follow a healthy diet and exercise regularly to help prevent ACS.


  • Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-e426. doi: 10.1161/CIR.0000000000000134
  • Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi: 10.1093/eurheartj/ehx393
  • Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315. doi: 10.1093/eurheartj/ehv320
  • Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-269. doi: 10.1093/eurheartj/ehy462
  • Yeh RW, Sidney S, Chandra M, et al. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155-2165. doi: 10.1056/NEJMoa0908610

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