Acute Coronary Syndrome is a composite of symptoms related to chest pains, shortness of breath, angina, and small and large heart attacks. If the blockage is not totally occluding the heart blood vessel, the symptoms may present as angina, chest or upper abdominal discomfort, sweating, shortness of breath or nausea. The symptoms may be associated with mild heart damage, as manifest by release of enzymes in the blood from damaged heart muscle cells. The clinical diagnosis is then a Non-ST Elevation Myocardial Infarction (NSTEMI). The electrocardiograms determine that distinct diagnosis based on the specific wave forms. The last situation is a major heart attack or ST Elevation Myocardial Infarction (STEMI) with specific defined electrocardiographic changes and significant enzymes rises in the blood. Frequently, chest discomfort will precede a heart attack by minutes, hours or days, and act as a harbinger of future more ominous cardiovascular events.
Time to diagnosis and therapy is very critical to prevent heart muscle damage and more severe heart attacks. Getting to the emergency room immediately with the onset of chest or upper abdominal discomfort, with or without possible shortness of breath, nausea or sweating, may make the difference between life and death. The difference may also be a small heart attack with a good prognosis and minor heart damage vs. a large one associated with congestive heart failure, fluid in the lungs and a poor prognosis. Calling the doctor to determine what to do usually delays the time to diagnosis and therapy; going to the emergency room facilitates the diagnosis and initiates definitive life-saving therapy. Substantial numbers of patients die at home without the aid of modern medical care readily available in the emergency room. In cardiology, time is related to heart muscle damage; saving the heart muscle is the most important priority. The larger the amount of heart muscle death, the worse prognosis for longevity and quality of life.
New therapies are available to open the blood vessels of the heart and prevent worsening damage from heart attacks. These new drugs affect the clotting system in the body and specifically the blood vessels in the heart to prevent a blood clot from clogging a cardiac blood vessel. Heart attacks are due to a clot forming in a cardiac blood vessel thereby preventing oxygen and other nutrients from getting to the heart muscle. This blockage leads to heart cell damage and death of the heart cell, called a myocardial infarction. Thrombolytic drugs may dissolve the clot, and anticoagulents may prevent future clots from forming. The faster these clot busting drugs are administered, the better the prognosis. Immediate cardiac catheterization and angiography are also used readily in many acute care hospital settings to open blocked arteries and improve heart function.
Anticoagulent drugs affect the platelets in the circulating blood. Platelets are involved with blood clot formation in the cardiac blood vessels. Blocking the action of platelets is an integral part of preventing future cardiac events and heart attacks. Several new antiplatelet are being evaluated to improve the survival and toxicity from myocardial infarctions. Plavix is the standard drug for blocking platelet induced clots; Effient recently became available for the same purpose in those patients undergoing catheterization and angioplasty.
The drugs that affect clotting are part of a whole protocol to treat angina and heart attacks. The drugs involved are aspirin and Plavix or Effient, beta-blockers, angiotensin receptor blockers, and cholesterol lowering drugs such as statins. Multiple clinical trials have demonstrated benefit from such a regimen to prevent second heart attacks and death in cardiac patients.
The most important message is that early diagnosis and treatment are essential for acute coronary syndrome. Get to the Emergency Room quickly. Call 911 and seek help as early as possible.
Dr David Korn and Dr Robert Rasken are the Directors of Aventura Heart Center. Aventura Heart Center provides the most comprehensive prevention and general cardiovascular services. It is a unique healthcare center offering state-of-the-art nuclear cardiac and stress thallium testing to effectively diagnose heart disease, ultrasound diagnostics and bone density testing in our office. Also offering complete lipid treatment, arrhythmia detection and pacer evaluation.
Aventura Heart Center is located in the Mount Sinai Aventura Building. 2845 Aventura Blvd. Suite 249. Office hours are Monday through Friday 9 a.m. to 5 p.m. To make an appointment, call 305 932 6061.
