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Acute coronary syndrome

Patients with acute coronary syndrome have some degree of coronary artery occlusion. The degree of
occlusion defines whether the acute coronary syndrome is: • unstable angina • non–ST segment
elevation MI (non-STEMI) • ST segment elevation MI (STEMI).The development of acute coronary
syndrome begins with a rupture or erosion of plaque, an unstable and lipid-rich substance. The rupture
results in platelet adhesions, fibrin clot formation, and thrombin activation.

What causes it

Patients with certain risk factors appear to face a greater likelihood of developing acute coronary
syndrome.

These factors include:

• diabetes

• family history of heart disease

• hypertension

• obesity

• high-fat, high-carbohydrate diet

• sedentary lifestyle

• menopause

• hyperlipoproteinemia

• smoking

• stress.

How it happens

Acute coronary syndrome most commonly results when a thrombus progresses and occludes blood
flow. (An early thrombus doesn’t necessarily block blood flow.) The effect is an imbalance in myocardial
oxygen supply and demand.

Degree and duration

The degree and duration of blockage dictate the type of infarct:


• If the patient has unstable angina, a thrombus partially occludes a coronary vessel. The thrombus is
full of platelets. The partially occluded vessel may have distal microthrombi that cause necrosis in some
myocytes.

• If smaller vessels infarct, the patient is at higher risk for MI, which may progress to a non-STEMI.
Usually, only the innermost layer of the heart is damaged.

• STEMI results when reduced blood flow through one of the coronary arteries causes myocardial
ischemia, injury, and necrosis. The damage extends through all myocardial layers. What to look for A
patient with angina typically experiences:

• burning

• squeezing