Disease Description (Causes and Symptoms)
- Definition summary: Acute coronary syndrome (ACS) refers to a condition in which the coronary arteries become partially or completely occluded due to acute thrombus formation or plaque destabilization within the coronary arteries, resulting in a sudden decrease in blood flow to the myocardium. Clinically, it includes ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS; NSTEMI/unstable angina).
- Main causes and pathophysiology: Rupture or erosion of a coronary atherosclerotic plaque causes platelet aggregation and thrombus formation, blocking the vessel; vasoconstriction may also occur, resulting in ischemia. Risk factors: high cholesterol (especially elevated LDL), hypertension, diabetes, smoking, obesity, physical inactivity, family history, etc.
- Main symptoms: Chest pain (a squeezing or pressing sensation, in the center of the chest), radiating pain (to the left arm, neck, lower jaw, or abdomen), shortness of breath, nausea and vomiting, cold sweats, dizziness, and palpitations. If symptoms are new or persist or worsen even at rest, consider it an emergency.
Treatment Methods and Precautions
- Initial emergency measures (recommended before/immediately after arrival at the hospital)
- Visit the emergency room immediately (especially in cases of new, severe chest pain).
- Administration of antiplatelet agents such as aspirin (e.g., 300 mg, chewed) is recommended in the emergency room or by emergency medical personnel, depending on the situation.
- Oxygen therapy: Performed when hypoxia is present (SpO2 < 90%).
- Nitroglycerin: Used to relieve chest pain; contraindicated in cases of hypotension or suspected right ventricular infarction.
- Analgesics (such as morphine) may be considered if pain persists, but are selective.
- Definitive reperfusion treatment
- STEMI: When possible, immediate coronary intervention (PCI, stent insertion) is the standard treatment and should be performed as quickly as possible. If PCI is not possible, thrombolysis (thrombolytic agents) may be considered within the appropriate time window.
- NSTE-ACS: Medication treatment or early coronary intervention is selected according to risk assessment (for high-risk patients, within 12–24 hours is recommended).
- Medication treatment (acute and maintenance phases)
- Antiplatelet agents: Aspirin + an additional P2Y12 inhibitor (such as clopidogrel, prasugrel, or ticagrelor) — selected according to treatment guidelines.
- Anticoagulants: Low-molecular-weight heparin or an irreversible anticoagulant (as determined by medical professionals).
- Statins: Early administration of high-intensity statins (e.g., atorvastatin or rosuvastatin).
- Beta-blockers: If there are no contraindications, administered during the acute phase or after the acute phase to reduce cardiac workload.
- ACE inhibitors/ARBs: Considered in cases of reduced left ventricular function or hypertension.
- Other: Treatment tailored to the condition, such as blood pressure and blood glucose control.
- Lifestyle management and secondary prevention
- Stop smoking, exercise regularly (after consulting a doctor), manage weight, follow a low-fat, low-sodium diet, and consume vegetables and fruit.
- Actively manage hypertension, diabetes, and hyperlipidemia.
- Continue taking medications consistently (the duration of aspirin, P2Y12 inhibitors, etc. is determined according to the lesion and whether a procedure was performed).
- Precautions and risk of complications
- Delayed treatment increases the extent of myocardial necrosis and raises the risk of death, heart failure, and fatal arrhythmias.
- Bleeding after reperfusion, stent thrombosis, restenosis, heart failure, myocardial rupture, ventricular aneurysm (aneurysm), and ventricular arrhythmias may occur.
- Exercise caution regarding bleeding when taking antiplatelet agents or anticoagulants (especially gastrointestinal bleeding, etc.) — the risk of bleeding should be explained before and after administration.
Outpatient Visit Checklist (Including Preparation Items and Example Questions)
- Preparation items and records
- A list of all medications currently being taken (including prescription drugs, OTC medications, and supplements) and the time they were most recently taken
- Records and dates of previous diagnoses (angina, myocardial infarction) and procedures (PCI, CABG) or surgeries
- Copies of recent test results (electrocardiogram, echocardiogram, coronary angiography, blood test results, etc.), if possible
- The time chest pain began, its duration and characteristics (a pain chart or notes), and factors that worsen or relieve the symptoms
- Lifestyle habits (smoking, alcohol consumption, amount of exercise) and family history (coronary artery disease at a young age)
- Examples of questions to write down in advance for the outpatient visit (from the patient)
- The time the pain started and its course (how much time has passed since it first occurred)
- Current medications and whether there are any allergies
- Recent test results or history of emergency visits, if any
- Changes in daily functioning (shortness of breath during exercise, limitations in daily activities, etc.)
Examples of General Questions to Ask the Doctor
- What are the expected short- and long-term side effects of this medication (e.g., aspirin or a P2Y12 inhibitor)?
- In my case, do I need reperfusion (PCI or thrombolysis)? When is the appropriate time?
- What is my risk of recurrence (at 1 year and 5 years), and what should I prioritize to reduce the risk?
- When can I resume daily activities (exercise, returning to work, driving, etc.)?
Examples of Disease-Specific Questions
- Based on my electrocardiogram and blood test results (including troponin), do I have STEMI or NSTE-ACS, and what reperfusion strategy is recommended (immediate PCI vs. observation after medication treatment)?
- How long should I take antiplatelet agents after stent insertion (as monotherapy or combination therapy)? What alternatives are available if there is a risk of bleeding?
(Note: If an emergency is suspected, go to the emergency room without delay. The information provided is general information; consult your treating medical professionals for individual medical care.)