Management of acute coronary syndrome

When a blood clot blocks a coronary artery, the heart muscle downstream is starved of oxygen. Management focuses on countering this reduced blood flow. All cases of acute coronary syndrome follow the same basic plan, but the specific approach depends on the electrocardiogram (ECG) finding: if the ST segment is elevated, it is a STEMI; if not, it is a non-ST elevation acute coronary syndrome (NST-ACS), which includes unstable angina and NSTEMI. STEMI patients usually have a completely blocked artery and receive more aggressive treatment, often including reperfusion therapy to reopen the vessel. NST-ACS patients typically do not have a full blockage; their management is guided by their risk of complications—low-risk patients can be managed with medication, while moderate- to high-risk patients benefit from early invasive procedures like coronary angiography and revascularization.

Medical therapy includes drugs to relieve chest pain, limit the size of the heart damage, and prevent clot formation. Clot-inhibiting drugs include antiplatelet agents (which stop platelets from clumping) and anticoagulants (which slow the clotting cascade). Long-term therapy is needed to prevent future events and complications. Women experiencing a heart attack are often taken less seriously than men, which leads to higher death rates among women.

Initial steps depend on the patient. Anyone with possible symptoms should call emergency medical services immediately. Patients with known coronary artery disease who have nitroglycerin should take one dose and call for help if symptoms do not improve within 2–5 minutes. Chewing non-enteric-coated aspirin is encouraged unless contraindicated. Patients should stay calm in a comfortable position—often sitting or sitting with knees folded, though they should choose what feels best. They should not be transported by private vehicle unless an ambulance is impossible (for example, in very remote areas with dangerous weather), and even then, someone trained in cardiac first aid should accompany them. Healthcare professionals must teach at-risk patients the symptoms and the need for urgent care.

Emergency medical services vary widely. Some provide only first aid and defibrillation; others have highly trained paramedics who can give oxygen, IV access, sublingual nitroglycerin, morphine, and aspirin. Advanced paramedic systems may offer even more.