Acute coronary syndrome

Acute coronary syndrome is a definite acute period of IHD.This syndrome in terms of the totality of its signs may be the first symbol of a possible impending myocardial infarction. It should be said that the acute coronary syndrome was created by doctors and for doctors. This syndrome was invented specifically to immediately begin therapy of the patient, without wasting time to determine the final diagnosis and differentiation of diseases. He is exhibited in the first hours, when the patient enters the hospital. Later, after certain studies have been carried out along with treatment, the diagnosis of acute coronary syndrome is removed and it is replaced by unstable angina or myocardial infarction.

At its core, acute coronary syndrome is a serious enough sign and can lead to even more serious complications. More often than not, as it was already written above, the primary diagnosis is acute coronary syndrome followed by myocardial infarction. Therefore, even though this diagnosis is only preliminary and primary, treatment should be started as soon as the diagnosis is made.

Acute coronary syndrome of the cause of

Before indicating the main causes that trigger the development of acute coronary syndrome, it is necessary to indicate which diseases it is divided into. Usually, the structure of acute coronary syndrome includes such pathologies: acute coronary syndrome( subsequently infarction), in which there is no ST segment elevation on the cardiogram;Similar acute coronary syndrome, but in which the rise of the ST segment is observed and there is unstable angina.

The ST segment, which was mentioned above, with its steady increase on the cardiogram tape will indicate acute blockage of several sections of blood vessels that feed the heart. It is this variant that most often is then transformed into a heart attack.

In turn, acute coronary syndrome, in which the above-described segment does not increase, will say that the muscle layer of the heart is affected and the syndrome of its acute ischemia has developed.

It is important to know that an acute coronary syndrome develops when the normal delivery of blood to the heart drops and its oxygen starvation starts. For the appearance of coronary insufficiency, it is necessary that both one and both of the trigger factors described above be performed.

The basis for the emergence of acute coronary syndrome will be the following: inflammation of the plaque, which is formed in the vessels as a result of atherosclerosis and tearing its "caps" - the top layer;Blockage of important coronary( cardiac) arteries with small thrombi and spasm of their walls. Of course, due to its prevalence, the main cause of the onset of acute coronary syndrome is rightly considered to be atherosclerotic vessel wall lesions. And the most important figure in the atherosclerotic cause of the appearance of acute coronary syndrome is a local manifestation of atherosclerosis - an atherosclerotic plaque.

Such pathological plaques are deposited in vessels, due to certain and rather complex biochemical processes. In the course of these processes, harmony is correlated in the ratio of two important structures that deal with the transport of cholesterol to the organs that need it: low-density lipoproteins( LDL) and high-density lipoprotein( HDL).In this ratio, low-density lipoproteins are the main transport of cholesterol, and high-density lipoproteins "insure" the body against an excess of cholesterol in it: they are able to draw excess cholesterol from the cells.

With atherosclerosis, lipoproteins having a low density become larger, and they gradually degenerate into atherosclerotic plaques. The same lipoproteins gradually change their structure and cause a powerful inflammation of the plaque. In the course of inflammation, the plaque opens( most often it happens where it is attached to the still healthy wall of the vessel) and certain substances come out of it that cause a powerful spasm of the arteries.

In addition, on the break site, processes that create thrombi are quickly triggered. This is due to the fact that a special tissue factor is liberated from the exposed plaque in large amounts. It is he who attracts the attention of the coagulating system, simulating the picture of the damage to the vessel, to which the body responds with speed.

Thus, it can be said that the causes of the development of acute coronary syndrome can be closely related, or flow from one another. For example, damage to the plaque, followed by a vasospasm and an attempt by the body to defend itself, creating a clot opening on the spot.

Acute coronary syndrome

symptoms As already clear, the main ones with an acute coronary syndrome will be signs of acute cardiac muscle starvation. And a bright manifestation of these signs, of course, will be pain. These pains are quite definite in nature. They do not have a clear limitation - they are often explained as "chest pain", "chest pain", etc. They are strong enough, pressing. There is a kind of symptom - a symptom of Levine, which just describes the magnitude of the pain in acute coronary syndrome. He says that if you ask a patient with an acute coronary syndrome to compare their pain with a gesture, then most likely he will show a clenched fist that will attach to the chest.

For clinical pain symptoms in acute coronary syndrome inherent irradiation - the ability of pain sensations to be given not only in the focus of pathology, but also in other parts of the body. With this disease, irradiation is extremely rich: it can give both a classic arm and shoulder blade( thanks to the ulnar nerve, which here will be the conductor of pain), and appear in the lower jaw or neck. In general, the prevalence of coronary pain can be from the eyebrow and up to the navel, everything will depend on the size of the lesion and the characteristics of the body.

Painful coronary attacks very quickly reach their peak( literally in one minute).They can last as long as 2 minutes, and up to 3 hours. Three hours are the maximum possible duration for pain in acute coronary syndrome, since it is during this time that myocardial cells die, and with them, nerve cells.

It is important to know that patients with acute coronary syndrome will try in every possible way to avoid any mention of the word "pain": they will try to replace it with words of discomfort, anxiety, uncomfortable sensations and so on. This is due to the fact that patients will be afraid that even the mention of pain will provoke its appearance again. This observation was called gnutz's schizokinesia.

There is also a certain set of starting factors that can trigger the appearance of pain in an acute coronary syndrome. They are called "tetrad E" or "four E"( the first letters of English names).This is physical exercise( exersize), emotional overloads( emotions), excessive eating habits and the impact of cold, windy weather on the development of the pain syndrome( exposure to cold).

Such patients will be characterized by restless behavior. They will, as they say, "toss" around the room. It is extremely difficult to force them to sit down or draw, as in this case their pain intensifies. In addition to pain, acute coronary syndrome will accompany shortness of breath and possible violations of the heart rhythm.

It is important to be able to distinguish between coronary syndrome, from similar "masks" of other diseases. Pain "pseudo-ischemic" will be distinguished by a clear restriction, a lesser weight. Such pain either lasts fleetingly, or is protracted( lasts more than 3 hours).It is dagger and sharp and can be accompanied by a sufficiently rich "emotional" symptomatology.

Acute coronary syndrome diagnosis

One of the most frequent and important assistant in the detection of acute coronary syndrome is, of course, electrocardiography. Use 12 standard leads, which allow you to catch any changes in the activity of the heart. In addition, it is electrocardiograms that help to determine the variation of acute coronary syndrome and to determine the appropriate treatment protocol.

So on electrocardiograms one can find changes in the position of an important "ischemic" ST interval, the presence of a terrible Q-symbol of necrosis and the transformation of T-wave. All these signs can make you think about a possible acute coronary syndrome.

Also now, a fairly common method of searching for acute coronary syndrome is the troponin test. Troponins are special proteins, the high content of which will indicate damage to the muscle layer of the heart.

In biochemical analysis, the detection of high levels of creatine phosphokinase and aspartate aminotransferase will be useful in determining ACS.Like troponins, they go to the bloodstream when the cells of the striated muscle type are damaged, where they are usually kept.

One of the most desirable methods to diagnose acute coronary syndrome is coronary angiography. It allows you to find narrowing in the parts of the coronary system of blood vessels. Coronarography can be paired with stenting. Thus, it is possible to quickly carry out diagnosis and simultaneous treatment, while quickly restoring the nutrition of the heart.

In addition, any patient with acute coronary syndrome should be diagnosed with the entire lipid profile. This is necessary in order to determine the level of cholesterol, lipoproteins characterized by low and high density, and to determine the ratio of fractions of lipoproteins to each other.

Acute coronary syndrome treatment of

Treatment of a syndrome characterized by acute deficiency of the coronary vascular system depends on its pathogenetic variant, especially on the presence or absence of changes in the ST segment on the cardiogram.

As already described above, the increase in this segment indicates that several vessels from the system supplying the heart are closed by thrombi. This condition is extremely threatening, because if the proper therapy of this condition is not started in time, then the myocardium will die very quickly and the patient may develop acute failure of all important functions of the heart.

Each subspecies of acute coronary syndrome has its own characteristics in the treatment. The subspecies of acute coronary syndrome accompanied by the "jump" of the ST segment speaks, as already described above, of thrombotic occlusion of the coronary arteries of the heart. Therefore, as soon as possible, it is necessary to restore the patency of the channel of the affected vessels of the coronary system. These problems are best helped by a procedure such as forced thrombolysis. It involves the introduction of thrombosporous substances( Heparin, Streptolysin, etc.).This procedure requires a clear consideration of all possible contraindications, as well as constant monitoring of the parameters of the coagulation system.

With a variation in acute coronary syndrome, in which there is no permanent increase in the ST segment, a completely different therapy technique is required. Here ischemic heart damage is observed, which means that the measures described above for the prompt removal of thrombi are not effective, therefore, they are not applied. Here the main attention will be paid to the elimination of ischemia, and the obstruction to genesis of thrombi will be considered as prevention.

The basic system of therapy with such a variation of acute coronary syndrome is "ABCD" therapy. It will include antiplatelet drugs that will protect the damaged areas from the possible settling of blood clots. Most often this line will be presented by Aspirin. In addition, if one year has not passed since the onset of acute coronary syndrome, within 1 year Aspirin is administered simultaneously with clopidogrel( two antiplatelet agents).Under the letter B, B-blockers were placed in this therapy, the letter C represents drugs that reduce the pathological cholesterol level. And the last letter in the therapy of coronary insufficiency syndrome is the so-called "dilators" - drugs that interfere with the production of angiotensin.