Treatment for acute coronary syndrome varies, depending on your symptoms and how blocked your arteries are.
It's likely that your doctor will recommend medications that can relieve chest pain and improve flow through the heart. These could include:
- Aspirin. Aspirin decreases blood clotting, helping to keep blood flowing through narrowed heart arteries. Aspirin is one of the first things you may be given in the emergency room for suspected acute coronary syndrome. You may be asked to chew the aspirin so that it's absorbed into your bloodstream more quickly. If your doctor diagnoses your symptoms as acute coronary syndrome, he or she may recommend taking an 81-milligram dose of aspirin daily.
- Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. If you're having a heart attack, the earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart. However, if you are close to a hospital with a cardiac catheterization laboratory, you'll usually be treated with emergency angioplasty and stenting instead of thrombolytics. Clotbuster medications are generally used when it will take too long to get to a cardiac catheterization laboratory, such as in rural communities.
- Nitroglycerin. This medication for treating chest pain and angina temporarily widens narrowed blood vessels, improving blood flow to and from your heart.
- Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure, which decreases the demand on your heart. These medications can increase blood flow through your heart, decreasing chest pain and the potential for damage to your heart during a heart attack.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
- Calcium channel blockers. These medications relax the heart and allow more blood to flow to and from the heart. Calcium channel blockers are generally given if symptoms persist after you've taken nitroglycerin and beta blockers.
- Cholesterol-lowering drugs. Commonly used drugs known as statins can lower your cholesterol levels, making plaque deposits less likely, and they can stabilize plaque, making it less likely to rupture.
- Clot-preventing drugs. Medications such as clopidogrel (Plavix) and prasugrel (Effient) can help prevent blood clots from forming by making your blood platelets less likely to stick together. However, clopidogrel increases your risk of bleeding, so be sure to let everyone on your health care team know that you're taking it, particularly if you need any type of surgery.
Surgery and other procedures
If medications aren't enough to restore blood flow through your heart, your doctor may recommend one of these procedures:
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- Angioplasty and stenting. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.
- Coronary bypass surgery. This procedure creates an alternative route for blood to go around a blocked coronary artery.
- Acute coronary syndromes. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/cardiovascular_disorders/coronary_artery_disease/acute_coronary_syndromes_acs.html. Accessed April 2, 2013.
- Acute coronary syndromes. American Heart Association. http://www.heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/Acute-Coronary-Syndrome_UCM_428752_Article.jsp. Accessed April 2, 2013.
- Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington, Minn.: Institute for Clinical Systems Improvement. https://www.icsi.org/_asset/ydv4b3/ACS-Interactive1112b.pdf. Accessed March 27, 2013.
- What is angina? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/angina/printall-index.html. Accessed April 2, 2013.
- Ryan TJ, et al. Initial evaluation and management of suspected acute coronary syndrome in the emergency department. http://www.uptodate.com/home. Accessed April 1, 2013.
- What do my cholesterol levels mean? American Heart Association. http://www.heart.org/HEARTORG/Conditions/Cholesterol/CholesterolToolsResources/Downloadable-Documents-for-Cholesterol_UCM_305648_Article.jsp. Accessed April 1, 2013.
- What is coronary heart disease? National Heart, Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/cad/printall-index.html. Accessed April 2, 2013.
- Alcoholic beverages and cardiovascular disease. American Heart Association. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Alcoholic-Beverages-and-Cardiovascular-Disease_UCM_305864_Article.jsp. Accessed March 22, 2013.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. April 22, 2013.