Acute Coronary Syndrome (ACS)

Acute myocardial infarction (AMI) is a serious complication of coronary artery disease (CAD) that occurs when a coronary artery, which supplies blood to the heart muscle, becomes suddenly blocked. This abrupt obstruction reduces blood flow to the myocardium, resulting in myocardial ischemia and tissue injury. Patients may present with chest pain, cardiac arrhythmias, or, in severe cases, sudden cardiac death.

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Causes of Coronary Artery Blockage

Coronary artery blockage, which restricts blood flow to the heart, is primarily caused by the gradual narrowing of the arteries due to age-related changes. Fatty deposits and calcium accumulate on the inner walls of the arteries, causing them to become thickened, rigid, and less flexible. As a result, the coronary arteries may narrow or become blocked, leading to insufficient blood flow to the heart muscle. This reduced blood supply can cause decreased oxygen delivery and, in severe cases, death of heart muscle tissue.

Symptoms of Coronary Artery Blockage

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

Stable Angina

Stable angina typically occurs during physical exertion, such as walking uphill, running, or during periods of emotional stress or anger. The pain usually subsides when the activity stops or when the individual rests. The duration of pain generally lasts between 3 to 5 minutes but may extend up to 20 minutes.

Patients often describe the pain as a sensation of tightness, pressure, or heaviness in the chest, which may radiate to the jaw or left arm. Additional symptoms may include palpitations, shortness of breath, dizziness, nausea, and a feeling of impending doom.

This type of pain occurs because the heart requires increased blood and oxygen during exertion or emotional stress, but the narrowed coronary arteries are unable to meet this demand. Once the individual rests, the pain typically resolves without causing 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. The pain often lasts longer than 20 minutes and may be accompanied by severe symptoms such as shock or heart failure.

Unstable angina indicates partial blockage of a coronary artery and carries a high risk of progressing to a myocardial infarction (heart attack). Additional symptoms may include palpitations, dizziness, blurred vision, nausea, vomiting, fatigue, shortness of breath, and signs of shock such as excessive sweating, cold extremities, or loss of consciousness.

Risk Factors for Coronary Artery Disease

• Age: Risk increases with age, particularly in men over 45 years and women over 50 years.
• Sedentary Lifestyle: Lack of physical activity, commonly associated with desk-based occupations, contributes to fat accumulation in blood vessels.
• Underlying Medical Conditions: High cholesterol, hypertension, diabetes, and obesity significantly increase the risk of coronary artery disease.
• Smoking: One of the major risk factors for coronary artery disease.
• Family History: A family history of coronary artery disease increases individual risk.

Diagnosis of Coronary Artery Disease

Physicians diagnose coronary artery disease using the following methods:

1. Initial Assessment: Evaluation of chest pain characteristics, including location, duration, and associated symptoms, along with a review of medical history and vital signs such as heart rate and blood pressure.

2. Blood Tests: Used to assess disease severity and identify contributing conditions such as diabetes, hypertension, and abnormal cholesterol levels.

3. Electrocardiography (ECG): Evaluates heart rhythm and detects myocardial ischemia or infarction. Abnormal ECG findings may indicate severe disease; however, a normal ECG does not completely rule out coronary artery disease.

4. Exercise Stress Test: Assesses cardiac function during physical exertion to identify chest pain or ECG changes associated with coronary artery narrowing.

5. Coronary Angiography: Involves the injection of contrast dye to visualize narrowed or blocked coronary arteries using X-ray imaging.

6. Echocardiography: Uses ultrasound waves to evaluate the structure and function of the heart.

Treatment Options for Coronary Artery Disease

Treatment depends on symptom severity, disease extent, patient age, and associated medical conditions.

1. Medication Therapy:
   Medications are prescribed to relieve symptoms and prevent complications. These may include antiplatelet agents, vasodilators, diuretics, and medications to control hypertension, diabetes, and cholesterol levels.

2. Patient Management During Treatment:
   • Carry prescribed sublingual medication at all times for immediate relief of chest pain.
   • Seek urgent medical attention if chest pain persists or worsens after medication.
   • Take medications exactly as prescribed and avoid adjusting dosages without medical advice.
   • Adopt lifestyle modifications, including a healthy diet, regular physical activity, stress management, and avoidance of smoking, alcohol, and excessive caffeine.
   • Attend regular follow-up appointments with healthcare providers.

3. Percutaneous Transluminal Coronary Angioplasty (PTCA):
   • A minimally invasive procedure used to widen narrowed coronary arteries using a balloon and/or stent.
   • Recommended for patients with severe arterial narrowing that does not respond adequately to medication.
   • The procedure involves inserting a catheter with a deflated balloon into a blood vessel and guiding it to the narrowed artery. The balloon is then inflated to compress plaque against the arterial wall, 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. The center offers comprehensive diagnostic and treatment services 24 hours a day. With an average door-to-balloon time of approximately 35 minutes, patients receive prompt treatment well within the critical 90-minute window, significantly improving survival outcomes. Medical staff continue close monitoring and care until the patient’s condition is stabilized.

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