Acute coronary syndrome
Acute coronary syndrome - it is a certain period of acute CHD.This syndrome in all of its features can be the first character of a possible impending myocardial infarction.It is said that the acute coronary syndrome is created by physicians for physicians. This syndrome was coined specifically to immediately begin treatment of the patient, without wasting time to determine the final diagnosis and differentiation of diseases.His exhibit in the early hours when the patient arrives at the hospital.Later, after a certain amount of research to be conducted simultaneously with the treatment, the diagnosis of acute coronary syndrome is removed and it is replaced by unstable angina or myocardial infarction.
Inherently acute coronary syndrome is a serious sign and can lead to more serious complications.In most cases, as already described above, with the primary diagnosis of acute coronary syndrome, myocardial infarction follows.Therefore, even though the fact that this diagno
Acute coronary syndrome causes
Before you specify the main reasons that trigger the development of acute coronary syndrome, it is necessary to point out what diseases it is subdivided.Usually in the acute coronary syndrome includes such diseases: acute coronary syndrome (heart attack later), in which there is no ST-segment elevation in the ECG;similar to acute coronary syndrome, but in which ST-segment elevation is observed and there is unstable angina.
segment ST, which was mentioned above, in its persistent elevations on ECG tape will indicate a severe blockage of several sections of blood vessels that feed the heart.It is this version more often then transformed into a heart attack.
In turn, acute coronary syndrome, in which the above segment is not increased, will be talking about what will affect the muscular layer of the heart, and it has developed a syndrome of acute ischemia.
important to know that acute coronary syndrome develops when normal service will decrease blood flow to the heart and run it anoxia.For the appearance of coronary insufficiency is necessary to perform one or both of the above factors launchers.
basis of the appearance of acute coronary syndrome will be the following reasons: inflammation of the plaque that forms in the blood vessels due to atherosclerosis and tear it "covers" - the top layer;significant blockage of the coronary (heart) arteries spasm of small blood clots and their walls.
course, because of its prevalence, the main reason for the launch of acute coronary syndrome are considered atherosclerotic lesions of the vascular wall.And the most important figure in the emergence of an atherosclerotic cause of acute coronary syndrome is a local manifestation of atherosclerosis - atherosclerotic plaque.
Such pathological plaques are deposited in the blood vessels due to specific and rather complex biochemical processes.During these processes, disturbed the harmony in the ratio of two important institutions that are engaged in the transport of cholesterol needed it agencies: lipoproteins characterized by low density (LDL) and high density lipoproteins having (HDL).This ratio lipoproteins having low density, are mainly transport cholesterol and lipoproteins having a high density of "fear" body from excess cholesterol in it: they are able to pull excess cholesterol from cells.
In atherosclerosis, lipoprotein low density becomes larger, and they gradually degenerate into atherosclerotic plaques.These lipoproteins gradually alter their structure and cause inflammation of the plaque powerful.During inflammation plaque opens (usually this is where it is attached to has a healthy vessel wall) and from it come certain substances that cause strong spasms of the arteries.
In addition, the site quickly started breaking processes that create clots.This occurs because of the disclosed plaque in a large number of special tissue factor is released.That he attracts the attention of the coagulation system, simulating a picture of the damage of the vessel, to which the body responds with speed.
Thus, we can say that the causes of generating the development of acute coronary syndrome may be closely related to each other, or flow from one another.For example, damage to the plaque, followed by a spasm of blood vessels and the body's attempt to defend itself, creating on-site disclosure clots.
Acute coronary syndrome symptoms
As is clear, the major acute coronary syndrome are signs of acute starvation of the heart muscle.And a clear manifestation of these signs, of course, will be pain.These pains are quite definite character.They do not have clear limitations - they are often explained as "chest pain", "pain in the chest," etc.They are strong enough, pressing.There is a peculiar symptom - a symptom of Levine, who just describes the amount of force the pain associated with acute coronary syndrome.He says that if you ask a patient with acute coronary syndrome compared with a gesture of his pain, it is likely that it will show a clenched fist, which is attached to the chest.
for clinical pain symptoms in acute coronary syndrome characterized by irradiation - the ability to be given pain not only in the area of pathology, but also in other parts of the body.In this disease irradiation is extremely rich: it can give and classically arm and shoulder blade (because of the ulnar nerve, which is a guide to pain), and appear in the lower jaw or neck.In general, the prevalence of coronary pain may be from the brow and to the navel, everything will depend on the size of the lesion and the characteristics of the organism.
Pain coronary events very quickly reach their peak (literally one minute).They can both take from 2 minutes and about 3 hours.Three hours is the maximum possible duration for pain in acute coronary syndrome, as it is during this time of myocardial cells die, and with them, and nerve cells.
is important to know that patients with acute coronary syndrome will be at pains to avoid any mention of the word "pain": they will try to replace it with words, discomfort, anxiety, feeling uncomfortable and so on.This is due to the fact that patients are afraid that even the mention of the pain will provoke her appearance again.This observation was called shizokineza Gnatta.
Also, there is a certain set of starting the factors that can trigger the appearance of pain in acute coronary syndrome.They are called "tetralogy E" or "four E" (the first letters of the English names).This exercise (exersize), emotional stress (emotions), excessive eating (eating) and the effects of cold, windy weather in the development of pain syndrome (exposure to cold).
These patients are characterized by restless behavior.They are what is called a "rush" around the room.They are extremely hard to get a seat, or draw, as in this case, their pain is getting worse.In addition to pain, acute coronary syndrome will be accompanied by shortness of breath and possible cardiac arrhythmia.
It is important to distinguish between coronary syndrome from similar "masks" other diseases.Pain "pseudo ischemic" will be different clearly defined, a lesser weight.The pain lasts a fleeting or a prolonged (lasting more than 3 hours).She and knife-sharp and can be accompanied by a sufficiently rich "emotional" symptoms.
Acute coronary syndrome diagnosis
One of the most common and important tool in the detection of acute coronary syndrome, of course, is electrocardiography.Use a standard 12-lead, which allows to capture any changes in the activity of the heart.In addition, it helps to determine the variation of the electrocardiogram of acute coronary syndrome and decide on the appropriate treatment protocol.
So on the electrocardiogram can be found significant changes in the provisions of "ischemic" ST interval, the presence of a formidable character Q-wave necrosis and transformations T wave.All these symptoms may get to think about a possible acute coronary syndrome.
also now quite common method of finding an acute coronary syndrome is a troponin test.Troponins - special proteins, increased the content of which will be evidence of damage to the muscular layer of the heart.
In the biochemical analysis useful for determining the ACS will detect high levels of creatine kinase and aspartataminotransferrazy.As troponins, they go into the blood when cells are damaged cross - striated muscle types, where they are commonly found.
One of the most desirable method to carry out, diagnosing acute coronary syndrome, coronary angiography is.It allows you to find areas of narrowing in the coronary vascular system.Coronary angiography can go to pair with stenting.Thus, you can quickly diagnose and simultaneous treatment, with the power of the heart to recover quickly.
addition to any patient with acute coronary syndrome is necessary to diagnose 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 the fractions of lipoproteins to each other.
Acute coronary syndrome treatment
Treatment of the syndrome characterized by an acute lack of coronary vascular system depends on its pathogenic variants, particularly the presence or absence of changes in the ST segment on the ECG.
As described above, the increase in this segment suggests that multiple vessels of systems that provide power to the heart, clots are closed.This condition is extremely terrible, because if time does not begin to run the appropriate treatment of this condition, it is extremely fast myocardium dies and the patient may develop an acute failure of important functions of the heart.
Each subtype of acute coronary syndrome is different treatment.Subspecies of acute coronary syndrome, accompanied by "a jump" ST segment says, as has been described above, a thrombotic occlusion of the coronary (coronary) arteries of the heart.Therefore it is necessary as soon as possible to restore the patency of coronary vascular bed affected system.These issues are best helps to solve such a procedure as the forced thrombolysis.It implies an introduction tromborasstvoryayuschih substances (Heparin, Streptolysin etc.).This procedure requires a clear accounting of all possible contraindications, as well as continuous monitoring of coagulation parameters.
When variation of acute coronary syndrome, in which a permanent increase of ST is not observed, require a completely different method of treatment.Here there is ischemic heart damage, and therefore the above steps to expedite the elimination of blood clots are not effective, so do not apply.It will focus on the elimination of ischemia and the genesis of blood clots obstacle will be considered as a prevention.
reference system therapy for a variation of acute coronary syndrome is «ABCD» therapy.It will include antiplatelet agents, who will protect the damaged areas of potential subsidence there clots.Most often, this will present a range of Aspirin.Also, if with the appearance of acute coronary syndrome did not pass even a year, then for 1 year at a time is assigned to aspirin and clopidogrel (antiplatelet two).Under the letter B in the treatment of B-blockers are located, the letter C are drugs that reduce abnormal cholesterol levels.And the last letter in the treatment of coronary insufficiency syndrome are so-called "dilators" - drugs that interfere with the development of angiotensin.