Treatment for Acute Coronary Syndrome
Acute Coronary Syndrome (ACS) requires urgent treatment and, in many cases, can be a medical emergency. A suspected ACS will probably mean an admission to hospital. You may be cared for in a coronary care unit, or an area within a hospital that specialises in treating people with heart conditions.
Early treatment (first 12 hours)
During the early hours following admission to hospital, your heart rhythm will be monitored closely by a cardiac monitor. You may also be given oxygen to help relieve your symptoms. Drugs to help reduce any pain you may be in will also be given.
Other early treatments (within the first 12 hours of symptoms beginning) may include:
Anti-platelet drugs
There are two anti-platelet (blood thinning) drugs of which aspirin is the most common. You should be given aspirin immediately it is suspected that you have ACS. Aspirin thins the blood making it less likely to form clots, reducing the risk of further heart problems or stroke.
Clopidogrel also thins the blood and may be prescribed if you are allergic to aspirin. It may also be given along with aspirin for short periods if there is a change in your cardiac rhythm or your Troponin level is raised or if you have further particular interventions for your ACS.
Another drug to help thin your blood may be given via a drip into your veins. This will be given if the doctors treating you think you have a high risk of having a heart attack or if they think you need particular further treatments.
Anti-coagulant drugs
Anti-coagulants are also drugs which help to thin the blood. You may receive small injections into your tummy for a few days to help prevent blood clots from forming if you have changes in your heart rhythm.
Beta-blockers
Beta-blockers reduce the work the heart has to do by slowing down the heart rate and lowering the blood pressure. They also help prevent future heart attacks and reduce the frequency of angina. They may not be suitable for you if you have asthma or other lung conditions.
Insulin
Your blood sugar levels will be monitored and you may be prescribed insulin if you are diabetic or if your blood sugar levels are found to be high.
Thrombolysis
Thrombolytic drugs, known as ‘clot busters’, are given as an injection into your veins which help to dissolve any clots blocking your arteries. Depending on where you live, you may be given this treatment by the ambulance staff called to take you to hospital, or you may be given it in hospital. This treatment is not suitable for everyone.
Percutaneous Intervention (PCI) or angioplasty
PCI involves stretching open narrowed areas of coronary arteries to improve the blood flow. Using a local anaesthetic, a catheter is inserted into an artery at your wrist, arm or groin. Dye is injected so that the arteries can be seen on an x-ray screen. The narrowed coronary artery is stretched by inflating a tiny balloon which is at the tip of the catheter.
In the majority of cases a metal stent will also be placed in the artery. A stent is a cylinder of metal mesh which acts like a scaffold to keep the artery open and prevents the narrowing coming back. The artery heals around the stent making it a permanent part of the artery. You will not be aware that it is there. Sometimes stents can be used which slowly release drugs directly to the narrowed area to help prevent the problem recurring. These are called drug eluting stents.
If this procedure takes place quickly, within 90 minutes of symptoms beginning, this is known as Primary PCI. If you have been given thrombolysis but it does not help you, your doctor may suggest rescue PCI. These interventions are not available in every hospital caring for patients with ACS.
Treatments beyond the first 12 hours
Once the the first 12 hours since the onset of your symptoms have passed, your doctor will consider other interventions and longer term treatments.
Interventions
If you are at risk of having a heart attack, you will be considered for
coronary angiography (angiogram or cardiac catheterisation). This is an x-ray examination of the coronary arteries and performed as a PCI but without the balloon. This shows up any narrowing in the arteries. NHS Tayside have produced further information on
Cardiac Catheterisation.
Not everyone who has to undergo coronary angiography will need an intervention. However, depending on whether there are any arteries affected by coronary heart disease, the cardiologist may need to consider
secondary PCI (PCI carried out after investigation) or a
coronary artery bypass graft (CABG) or ‘bypass’.
Bypass surgery can be performed on more than one narrowed coronary artery hence ‘double’ and ‘triple’ bypass surgery. It is carried out under a general anesthetic.
The surgeon literally bypasses the affected artery by using a blood vessel taken from the leg, arm or chest, to provide a new route for the blood supply to the heart. It involves opening the chest and having a heart and lung machine take over the circulation while the heart is stopped during the operation.
The majority of people have no angina after this operation. For others, there may still be some angina and tiredness. This is because some smaller arteries may remain narrowed. In this case drug treatment will still be vital to get the best quality of life possible.
Beating Heart Surgery: This name refers to a bypass operation that can be done while the heart is still beating. Sometimes the wound can be smaller than usual. There are a small number of surgeons who are doing this procedure and it is only suitable for a small number of people. You would need to stay in hospital for 5-7 days following bypass surgery.
Drug treatments for Acute Coronary Syndrome
Aspirin: Aspirin will be prescribed as a lifelong therapy. It occasionally upsets the stomach so take your tablet with or after meals.
Clopidogrel: You will need to take clopidogrel for either 4 weeks or 3 months, depending on the type of ACS you have. Clopidogrel will also be prescribed for up to a year if you have had PCI and a stent inserted.
Beta-blockers: If you have unstable angina or signs of damage to your heart muscle, you should be considered for long-term beta-blockers.
Calcium channel blockers: These help to relax the arteries lowering blood pressure and reducing the work the heart has to do. Sometimes they are used for people who are not able to take beta-blockers.
ACE inhibitors: These also help to relax the arteries lowering blood pressure and reducing the work the heart has to do. They are also known to act preventatively in reducing the risk of heart attacks and stroke in people who have coronary heart disease. They can cause an annoying cough.
Angiotensin Receptor Blockers: These are used when ACE inhibitors are not suitable.
Cholesterol lowering drugs (statins): Even if your cholesterol is not especially high your doctor may prescribe tablets as they reduce your risk of a heart attack. These drugs are usually taken at night. They can sometimes cause muscle pains which if they occur, should be reported to the doctor.
Eplereone: You should be considered for eplereone (an aldosterone receptor antagonist) if you have had a heart attack and have diabetes or signs of heart failure.
Nitrates: Nitrates work by widening (dilating) the blood vessels and therefore reduces the work of the heart. Nitrates come in a number of forms:
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GTN: GTN spray can be taken under the tongue to relieve the symptoms of angina or to prevent the pain from coming on e.g. before climbing a hill. GTN also comes in tablet form. (For further information, visit ‘How to take your GTN’)
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Nitrate Tablets: Taken on a regular basis they reduce the number of angina attacks and improve your ability to take exercise. Nitrates should be taken at the times prescribed for them to work effectively.
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Nitrate Patches: With nitrate patches the medicine is absorbed through the skin by direct contact. They should be applied on the chest or back and not directly over the heart. Only one patch should be used a day, which should be removed at night unless specifically being used to combat night time angina. Apply the patch to a different area of skin every time. Do not apply the patch to inflamed or cracked skin (the medicine can be absorbed too rapidly).
The information in this page has been adapted from the CHSS leaflet Heart Attack: A Guide to your Recovery.
Last updated: 23/11/2007