Conditions

Acute Coronary Syndrome

Sudden chest pain should never be ignored - early assessment can help identify heart-related conditions before they become serious

Acute Coronary Syndrome is a medical emergency encompassing three related conditions — STEMI, NSTEMI, and unstable angina — all caused by sudden, severe reduction in blood flow to the heart muscle. Rapid diagnosis and treatment are critical: every minute of delayed intervention increases the risk of permanent heart muscle damage or death.

Types of ACS

• STEMI (ST-Elevation Myocardial Infarction) is a complete coronary artery blockage causing full-thickness heart muscle injury. It requires immediate emergency angioplasty to restore blood flow.
• NSTEMI (Non-ST-Elevation Myocardial Infarction) involves partial arterial occlusion with detectable heart muscle damage on blood tests. Urgent cardiac catheterisation is typically required within 24–72 hours.
• Unstable Angina presents with chest pain at rest or minimal exertion without detectable muscle injury, but signals imminent risk of progression to full heart attack.

Symptoms

The hallmark symptom is chest pain, typically described as crushing pressure, tightness, or heaviness, radiating to the arm, jaw, neck, or back. Associated symptoms include breathlessness, diaphoresis (cold sweats), nausea, and sudden fatigue. Women, older adults, and diabetic patients frequently present atypically with back pain, indigestion-like discomfort, or unexplained fatigue without classic chest pain.

Causes & Risk Factors

ACS most commonly results from rupture of an atherosclerotic plaque within a coronary artery, triggering acute blood clot formation and vessel occlusion. Key risk factors include hypertension, hyperlipidaemia, diabetes, smoking, obesity, and family history of premature coronary artery disease.

Diagnosis

Diagnosis is established through a 12-lead ECG, serial cardiac troponin blood tests, and clinical assessment. Echocardiography evaluates heart function and wall motion abnormalities. Coronary angiography provides definitive mapping of arterial blockages and guides revascularisation decisions.

Treatment

Emergency treatment for STEMI centres on primary percutaneous coronary intervention (PCI), angioplasty and stenting to restore coronary blood flow as rapidly as possible. NSTEMI and unstable angina are managed with antiplatelet therapy, anticoagulation, and early invasive coronary angiography. Coronary artery bypass surgery (CABG) is reserved for complex multi-vessel disease or where PCI is not feasible. Long-term management includes statins, beta blockers, ACE inhibitors, and dual antiplatelet therapy to prevent recurrence.

When to Call Emergency Services

Call 995 immediately if you experience chest pain lasting more than 15 minutes, chest discomfort with breathlessness or sweating, or sudden collapse. Do not drive yourself to hospital. ACS is a time-critical emergency, earlier intervention directly preserves more heart muscle and improves survival.

For post-ACS follow-up, cardiac risk assessment, or a second opinion, Dr. Peter Chang consults at Paragon Medical Centre, Orchard Road. Book an appointment today.