Acute Coronary Syndrome
EDP Column by Dr Ketan Dhatariya

When the heart is deprived of oxygen the nerve supply to it may be damaged. This lack of oxygen is caused by an imbalance between the demand for oxygen by the heart and the ability of the arteries to provide an adequate oxygen supply. This damage causes the pain that is known as angina. However, it is important to recognise that not everyone gets chest pains. Some people may get short of breath, nauseated, or sweaty on exertion. Others may get pain in their neck, jaw or arm when they exert themselves.

If the heart is deprived of oxygen for a long time, then the cells of the heart muscle also start to be damaged and may die off. This is known as a heart attack. However, there are number of things that would also have been taken into account to decide what the cause of the chest pain was. These included asking you a number of questions about your general health – in particular asking you about your personal ‘risk factors’ associated with heart disease such as if you had had angina or a heart attack before, if you have diabetes or high blood pressure, if you have been a smoker and so on. You probably had an electrocardiogram (ECG) and the doctors assessing you would have taken some blood to test for changes in the blood that are associated with damaged heart muscle.

Depending on your answers and the results of the test, you may have had one of four different possible diagnoses: That you had a heart attack, with the changes in the tests showing significant heart muscle damage. You may have had a heart attack without the tests showing significant damage. Thirdly, you may not have had a heart attack, just a lack of oxygen to the heart muscle causing angina, but not severe enough to damage the heart muscle badly, or it may not have been heart related. The first three options form the spectrum of conditions known as ‘acute coronary syndrome’.

It is important to make the correct diagnosis because it determines the treatment that you get in the short term in hospital and when you leave. There are a number of medications that have been shown to help prevent the symptoms getting worse, and reduce the chances of another episode of acute coronary syndrome. If you are not sure why you have been given some medication, it is important you discuss them with your GP or pharmacist. However if you are a smoker, the single most important thing that can be done to help prevent heart problems is to stop.