Understanding Acute Coronary Syndromes: Types, Symptoms, and Prevention

Acute coronary syndromes (ACS) refers to a group of conditions linked to chest pain, including unstable angina and myocardial infarction (heart attack).

Unstable Angina -> NSTEMI (Heart Attack) -> STEMI (Major Heart Attack)

Acute coronary syndromes vary in seriousness depending on the size of the blockage preventing supply of blood to the heart which means less oxygen in the body. When the blood is starved of oxygen, this results in severe chest pain.

Most people are diagnosed with having an acute coronary syndrome after presenting to A&E with an episode of chest pain. It is extremely important not to ignore chest pain as the longer this goes untreated the more likely it is to escalate to a major heart attack or cause lasting damage to the heart.

Unstable Angina

Unstable angina is characterised by chest pain that occurs even when resting and this is more serious than when angina is stable. Stable angina has chest pain that usually only occurs on exertion like when exercising.

People with unstable angina are at greater risk of having a heart attack. Medication and lifestyle changes can help to control symptoms and reduce the risk of progression to heart attack.

NSTEMI

An NSTEMI is a form of heart attack where there is a partial or temporary blockage of the blood vessels supplying the heart, resulting in lasting damage.

STEMI

A STEMI is the most serious form of heart attack and results in changes to the electrical activity of the heart and is diagnosed by an ECG.

Those with STEMI will experience the most severe signs and symptoms and are at greater risk of long-term complications.

Common Symptoms of Acute Coronary Syndromes

-          Chest pain that does not go away on rest – particularly pain that lasts longer than 15 minutes.

-          Chest pain that radiates to your arm, neck, jaw, stomach or back.

-          Feeling dizzy, faint, nauseous and/or sweaty.

-          A sense of ‘doom’ or a sudden feeling of anxiety similar to a panic attack.

-          Coughing / wheezing.

If you experience any of the above symptoms please dial 999 immediately. You may be advised to take 300mg of Aspirin so ensure you have some in the house if you believe you may be at risk.

Top Tips to Stay Healthy

You can do the following to reduce your risk of acute coronary syndromes and keep your heart healthy:

-          Controlling blood pressure by keeping active – you should aim to complete 150 minutes of moderate exercise activity per week (or 75 minutes of intense activity) and reduce levels of stress.

-          Maintain a healthy weight and diet to manage cholesterol and blood sugar levels.

-          Limit alcohol consumption by sticking to the recommended 14 units a week of alcohol, spread evenly throughout the week.

-          Quit smoking – chemicals in cigarettes can cause blood to thicken. The BHF has some great facts and figures that outline the benefits of quitting smoking and you can find local smoking cessation services near you here.

-          Cardiac rehabilitation may help you get your life back to normal quicker.

Further Support

Those that have experienced an acute coronary syndrome will be offered medication to prevent it from recurring – this is known as secondary prevention.

Experiencing an acute coronary syndrome can be overwhelming as you may be discharged from hospital with 5+ new medicines.

Your pharmacist can help you to understand your new diagnosis and how each of your new medicines is important, ask to be enrolled into the New Medicines Service (though you will likely be asked by your Pharmacy!) when you receive your first prescription after discharge, and you’ll get a free consultation and follow up with the opportunity to ask any questions or voice any concerns you have about your new medicine. This is a free NHS service.

Sources

·         Banerjee, Shrilla. “Non ST- Elevation Myocardial Infarction.” BMJ Best Practice, BMJ, 28 Sept. 2023, https://bestpractice.bmj.com/topics/en-gb/3000113

·         British Heart Foundation. “Heart Attack.” BHF, Mar. 2023, www.bhf.org.uk/informationsupport/conditions/heart-attack

·         Joint Formulary Commitee. Acute Coronary Syndromes, NICE, Oct. 2023, bnf.nice.org.uk/treatment-summaries/acute-coronary-syndromes/

·         NICE CKS. “Chest Pain.” Clinical Knowledge Summaries, NICE, Aug. 2022, cks.nice.org.uk/topics/chest-pain/