ACS (Acute Coronary Syndrome)

In a clinical context, "ACS" most commonly refers to Acute Coronary Syndrome. This is an umbrella term for a spectrum of conditions associated with sudden, reduced blood flow to the heart, typically due to atherosclerotic plaque rupture and thrombus formation in the coronary arteries. The main clinical entities under ACS are:

• Unstable angina
• Non–ST-elevation myocardial infarction (NSTEMI)
• ST-elevation myocardial infarction (STEMI)

Key features:

• Presents with acute chest pain, often described as pressure or heaviness, sometimes radiating to the arm, neck, or jaw.
• May be associated with diaphoresis, dyspnea, nausea, or syncope.
• Diagnosis is based on clinical presentation, ECG changes, and cardiac biomarkers (e.g., troponin).
• Management includes antiplatelet therapy, anticoagulation, statins, beta-blockers, and, when indicated, urgent revascularization (PCI or CABG).

Patients should seek immediate medical attention for possible acute coronary syndrome (ACS) if they experience symptoms suggestive of myocardial ischemia. The classic presentation is new, severe, or persistent chest pain—often described as pressure, tightness, or heaviness—typically lasting more than a few minutes and not relieved by rest. The pain may radiate to the arms (especially the left), neck, jaw, back, or epigastrium. Associated symptoms such as diaphoresis, shortness of breath, nausea, vomiting, or unexplained fatigue—particularly in women, older adults, or those with diabetes—should also heighten suspicion, even if chest pain is absent or atypical.

Key indications to seek urgent help include:

• Chest discomfort at rest, especially if it lasts more than 5–10 minutes
• Chest pain with exertion that does not resolve promptly with rest
• Chest pain accompanied by dyspnea, diaphoresis, syncope, or palpitations
• New or unexplained symptoms in high-risk individuals (e.g., known coronary artery disease, diabetes, advanced age)
• Any sudden, severe, or unexplained symptoms suggestive of ACS

Patients should be advised to call emergency services (not drive themselves) if ACS is suspected, as prehospital care and rapid transport can be lifesaving. Delays in seeking care are associated with worse outcomes, so a low threshold for activating emergency response is appropriate.

Atypical presentations—such as isolated dyspnea, nausea, abdominal pain, or profound fatigue—are more common in women, older adults, and those with diabetes, and should not be dismissed. CALL 911 ASAP!

Author

Paddy Kalish OD, JD and B.Arch Author and Blogger