ACUTE CORONARY SYNDROME: CHALLENGES AND MANAGEMENT STRATEGIES

Abstract

Acute Coronary Syndrome (ACS) encompasses a spectrum of serious cardiac conditions characterized by an abrupt reduction in blood flow to the myocardium, resulting in ischemia and potential necrosis. This syndrome manifests in different forms, including unstable angina, ST-segment elevation myocardial infarction (STEMI), and non-ST-segment elevation myocardial infarction (NSTEMI), each with distinct diagnostic and therapeutic nuances. Atherosclerosis, a chronic inflammatory process that leads to the formation of fatty plaques in the coronary arteries, is the main cause of ACS. The rupture or erosion of these plaques triggers the formation of thrombi, obstructing blood flow and compromising the oxygenation of the heart muscle. The clinical presentation of ACS is variable, but chest pain is the most common symptom, frequently described as tightness, pressure, or burning, radiating to the upper limbs, jaw, or back. However, atypical manifestations, such as dyspnea, epigastric discomfort, nausea, vomiting, or syncope, can occur, especially in the elderly, women, and diabetics, making diagnosis difficult. The electrocardiogram (ECG) is a fundamental diagnostic tool in ACS, allowing the identification of characteristic patterns that aid in risk stratification and therapeutic decision-making. ST-segment elevation on the ECG suggests acute coronary occlusion, indicating the need for immediate intervention to restore blood flow. Treatment of ACS aims to relieve pain, halt the progression of ischemia, limit the size of the infarct, and prevent complications. Drug therapy includes antiplatelet agents, anticoagulants, nitrates, and beta-blockers, which act to stabilize the patient and prevent thrombotic events. Myocardial revascularization, through percutaneous coronary intervention (PCI) or thrombolytic therapy, is essential to restore blood flow and minimize damage to the heart muscle. Percutaneous coronary intervention (PCI), which consists of angioplasty with stent implantation, is the preferred method of revascularization, especially in STEMI (ST-segment elevation myocardial infarction).