Symptoms and causes of Acute Coronary Syndrome

Acute Coronary Syndrome is a term used to describe a range of problems with the heart – from unstable angina (a threatened heart attack) to an actual heart attack (myocardial infarction).

What are the symptoms of Acute Coronary Syndrome?

Acute Coronary Syndrome would be felt as angina.  This is typically felt as discomfort in the middle of the chest and is the heart complaining that it is not getting sufficient oxygen.

It may start off as a dull pain or ache.  It has been described as heaviness, burning, tightness, constriction or squeezing sensation, a heavy weight or pressure.  Angina can also cause breathlessness, more than you would expect with exercise or even when resting.  In some people angina can feel very similar to indigestion or heartburn.

Angina pain may spread to the throat or neck, to the jaw, to the shoulders, to the left or right arm or both (going down the inside of the arms) and sometimes to the back or stomach.

Occasionally, angina pain occurs in one of these places without chest pain, for example, pain in the arm.

Stable angina goes away when you stop the activity that brought it on or after taking medication to relieve the pain of angina.

Acute Coronary Syndrome can present as unstable angina, when angina attacks occur more frequently.  Attacks may even occur at rest or wake you from sleep. This may be an indication of a worsening condition and you should see your doctor urgently. New symptoms of angina are also classed as unstable angina.

Acute Coronary Syndrome can also present as a heart attack, usually when the pain of angina will not go away, despite rest and/or taking medication to help relieve the angina. This is an emergency situation and you should dial 999 if this happens to you.

 

What causes Acute Coronary syndrome?

The heart is the centre of the body’s circulation system, delivering fresh, oxygen rich and nutritious blood throughout the body.

The muscular pumping action of the heart is achieved by electrical signals being sent through the heart, through special cells, telling the muscles when to contract and relax.

The heart muscle (myocardium) has to work very hard but it is very capable and rarely needs to work to its full capacity when healthy.  Because it is a muscle it also requires its own efficient blood supply to supply to provide the oxygen and nutrients it needs.  It gets this supply through three main coronary arteries. 
   
In some people, a fatty deposit builds up in the lining of the arteries throughout the body, over a number of years. This deposit narrows the artery and eventually reduces the amount of blood that can get through.  This deposit is called ‘atheroma’.

When this build up of atheroma affects the coronary arteries it is called ‘coronary artery disease’ or ‘coronary heart disease’ (CHD for short).

If the atheroma is small and the artery is only partially blocked, the CHD may present as a stable angina. If the disease progresses and the artery becomes more narrowed or completely blocked, the disease may present as acute coronary syndrome (unstable angina or a heart attack).

 

What causes coronary heart disease?

You are more likely to develop coronary heart disease if you:

smoke cigarettes (or cigars) regularly	have high blood cholesterol level
have high blood pressure	do not get enough exercise
are diabetic	have an unhealthy diet
are overweight	drink too much alcohol
have a family history of coronary heart disease

These are risk factors which increase the risk of developing CHD or making it worse.  The risks don’t just add up, they multiply.  For further information on reducing your risk of developing coronary heart disease, visit the "Preventing heart disease" section.

The information in this page has been adapted from the CHSS leaflet Heart Attack: A Guide to your Recovery.