What You Should Know about Acute Coronary Syndromes

Every year, more than 7 million patients around the world are diagnosed with acute coronary syndromes. In the United States, over 1 million patients are hospitalized annually. This month in JAMA, Dr. Deepak L. Bhatt, of the Brigham’s Division of Cardiovascular Medicine, and colleagues published a review article about diagnosis and treatment of this common condition. Dr. Bhatt told us more about ACS and what people should know in this Q&A:?

Q: What is acute coronary syndrome?

A: Acute coronary syndromes (ACS) refer to conditions in which the blood supply to the heart is suddenly reduced. There are many types and causes of ACS, which include heart attacks and unstable angina (which means severe chest discomfort that occurs at rest, but not a full-blown heart attack).

Q: What causes ACS?

A: There are several underlying causes of ACS, but most forms involve a coronary artery with a cholesterol-rich plaque that ruptures due to inflammation, exposing its inner contents to flowing blood, leading to a blood clot.

Q: What are the most common symptoms of ACS and how is it diagnosed?

A: The most common symptom of ACS in both men and women is chest discomfort at rest, which occurs approximately 80 percent of the time. However, nonspecific symptoms, such as shortness of breath, occur approximately half the time, either alone or, more often, along with chest pain.

Q: What kinds of treatments can help someone with ACS?

A: Most patients with ACS should go to the catheterization laboratory (“cath lab”) for a minimally invasive coronary angiogram. Approximately 60 percent will end up getting a stent, 10 percent undergo coronary artery bypass graft (“CABG”) surgery, and 30 percent receive medications only.

Q: What is the prognosis for patients?

A: Patients who have survived an ACS have a substantial risk of future heart attacks and strokes, as well as needing repeat procedures such as stenting or CABG. Lifestyle modification (plant-based diet, exercise, weight loss, smoking cessation) and intense medical therapy (treatment of elevated cholesterol, triglycerides, blood pressure, and diabetes, as well as anti-clotting medications) can greatly decrease the risk of future complications.

Q: What public health message do you want to share with patients?

A: If you have significant chest discomfort at rest, don’t hesitate: Call 911.