Acute Coronary Syndrome in Young Adults - An Overview

Introduction:

Coronary artery disease (plaque accumulation in the arterial walls that carry blood to the heart causes coronary artery disease) is a leading global killer. Younger patients have different risk factors, clinical presentation, coronary artery involvement, and outcomes. Substance misuse, coronary artery abnormalities, hypercoagulability (greater likelihood of blood clotting and clot formation), and oral contraceptive use in young women may also cause myocardial infarction (produced by a reduction in blood flow to a section of the myocardium or its complete stoppage) in young individuals. ACS in young people has devastating implications for quality of life and survival, making it a major issue for patients and consulting physicians.

How to Categorize Acute Coronary Syndrome?

It is essential to classify acute coronary syndromes because treatments vary depending on the specific syndrome. The classification includes unstable angina and two different forms of a heart attack.

Angina instability is a variation in the course of angina symptoms (chest pain), including angina and the onset of severe angina symptoms. People with unstable angina do not exhibit ECG or blood test indicators of a heart attack.

Non-ST-segment elevation myocardial infarction (NSTEMI) is a heart attack that can be identified by blood tests but does not exhibit typical ECG changes (ST-segment elevation).

ST-segment elevation MI is a type of heart attack that can be identified by blood tests and produces characteristic ECG alterations (ST-segment elevation).

What Are the Symptoms of the Condition?

The symptoms of acute coronary syndromes appear similar, and it is frequently impossible to differentiate the syndromes based solely on symptoms. The symptoms of unstable angina are similar to those of angina pectoris:

• Intermittent pressure or pain beneath the breastbone (sternum).
• Heaviness or discomfort on the chest.
• Discomfort may occur in either the shoulder or the inside of either arm and the back, throat, jaw, or teeth.
• People have more frequent or severe angina attacks or attacks that occur at rest or after less physical exercise.
• Shortness of breath.
• Exhaustion.
• A shift in chest pain and discomfort could lead to a heart attack.
• Fainting sensation.
• Excessive sweating.
• Nausea.
• Shortness of breath.
• The heavy pounding of the heart (palpitations).

A quiet heart attack may not be recognized unless an ECG is performed routinely sometime later. Heart murmurs and other irregular heart sounds can be heard with a stethoscope in the early stages of a heart attack.

What Are the Complications?

Individuals experiencing a myocardial infarction may also encounter enduring complications. The severity of acute coronary syndromes is contingent upon the extent of myocardial injury, which is causally linked to the location and duration of coronary artery occlusion. If a significant portion of the cardiac muscle is obstructed, the heart's ability to pump blood may be compromised, resulting in potential cardiac enlargement and subsequent heart failure. Suppose an obstruction impedes blood circulation to the cardiac electrical system. In that case, it may alter the heart's rhythm, which could potentially culminate in arrhythmia and an abrupt cessation of cardiac function (cardiac arrest).

What Are the Diagnostic Criteria?

1. Electrocardiography: ECG is the most important initial diagnostic procedure when suspected of cardiac acute syndrome.This process shows graphically how the electrical current that causes each heartbeat is generated. The anomalies on the ECG can aid in identifying the locations of cardiac muscle injury. It could be more difficult for doctors to identify the most recent damage in a patient who has already experienced heart issues, which can change the ECG.

2. Cardiac Markers: Cardiac markers are biomolecules that diagnose and monitor various cardiac conditions.

• The diagnosis of acute coronary syndromes can be facilitated by quantifying specific substances, known as cardiac markers, in the bloodstream.
• The compounds are typically present within the cardiac muscle tissue; however, their release into the bloodstream is contingent upon cardiac muscle damage or necrosis.
• The most frequently assessed biomarkers are cardiac muscle proteins, namely troponin I and T, and an enzyme called CK-MB (creatinine kinase, myocardial band subunit).
• The concentration of certain biomarkers in the bloodstream undergoes a rapid increase within a time frame of six hours following myocardial infarction. It persists at an elevated level for several days. Cardiac markers are typically assessed upon admission to a medical facility and subsequently at six to 12 hours over 24 hours.

3. Additional Testing: Additional diagnostic examinations may be conducted concurrently or immediately after hospital admittance.

• These diagnostic assessments are employed to ascertain the necessity of supplementary medical intervention or the probability of experiencing further cardiovascular complications.
• This medical procedure facilitates the identification of abnormal heart rhythms (arrhythmias) or instances of insufficient blood flow without accompanying symptoms (silent ischemia) by physicians.
• Performing an exercise stress test, which involves electrocardiography during physical activity, either before or close to discharge, can aid in assessing the post-heart attack condition of the individual and identifying any ongoing ischemia. Pharmacological intervention may be advised if these procedures identify anomalous cardiac rhythms or ischemic conditions.
• In cases where ischemia persists, medical professionals may suggest the use of coronary angiography as a means of assessing the feasibility of performing coronary artery bypass graft surgery or percutaneous coronary intervention to reinstate blood flow to the heart.

What Is the Prognosis?

The most dangerous time for a person experiencing a heart attack is during the initial few hours before they reach the hospital. People with a heart attack may die; therefore, prompt medical attention must be sought if someone suspects a heart attack. The majority of fatalities occur within the first three to four months, typically in patients who continue to experience angina, ventricular arrhythmias, or heart failure. When the heart has enlarged after a heart attack, the prognosis is worse than if the heart size remains normal.

What Are the Treatment Methods?

1. Drug Therapy:

• The first step in treating a heart attack is to be admitted to the hospital as soon as possible to restore blood flow to the affected artery. People having a heart attack should take Aspirin after calling an ambulance; if not taken at home or by emergency personnel, it is delivered to the hospital. The medication increases survival by reducing the coronary artery clot.
• Drugs are used to avoid blood clots, reduce anxiety, and shrink the heart. People who have had a heart attack may require these medications for some time. Drugs reduce cardiac effort both during and after a heart attack.
• A beta-blocker is routinely used to minimize tissue damage by slowing the heart rate. Slowing down makes the heart work less and reduces tissue damage.
• Most people are given Heparin, an anticoagulant, to avoid blood clots.
• Nitroglycerin alleviates pain by reducing heart workload and perhaps dilating arteries. It is typically taken intravenously after being delivered sublingually. When nitroglycerine fails to treat pain and anxiety, doctors will prescribe Morphine.
• Many individuals can benefit from ACE medicines by reducing cardiac hypertrophy and increasing survival. As a result, these medications are typically prescribed indefinitely in the first few days after a heart attack.
• Statins have long been used to prevent coronary artery disease, but doctors have recently discovered that they can also treat individuals with acute coronary syndrome. Non-statin users obtain one from their doctor.

2. Arterial Dilation: Determining the timing and manner for opening an artery that is blocked is contingent upon the specific form of acute coronary syndrome. There are various methods for unblocking coronary arteries:

3. Percutaneous Interventions

• Anticoagulants dissolve blood clots; as for the ST-segment elevation MI patients, bypass surgery (coronary artery bypass grafting) clears the blockage quickly, sparing heart tissue and enhancing survival. The method of clearing is probably less important than the timing because the sooner the artery is cleaned, the better the outcome.
• Percutaneous cardiac treatments (PCI), including angioplasty and stent insertion, are the best strategy for unblocking blocked arteries in an ST-segment elevation MI if performed within 90 minutes of hospital arrival.

4. Drugs That Dissolve Clots

• The injectable medications used to treat coronary artery disease open the arteries.
• Thrombolytic drugs include Streptokinase, Tnk-Tpa, Alteplase, And Reteplase.
• Although they work best when administered rapidly, these drugs can be effective within three hours and may be beneficial for up to 12 hours after the person arrives at the hospital. Most people who are given thrombolytic medications require PCI before leaving the hospital.
• The thrombolytic drugs might cause bleeding; they are not given to people who have digestive tract bleeding, extremely high blood pressure, recent strokes, or recent surgery. Only healthy elderly people can be given thrombolytic medications.
• Non-ST-segment elevation MI and unstable angina do not usually benefit from urgent PCI or thrombolytic medicines. However, clinicians commonly perform PCI on the first or second day of hospitalization. If symptoms increase or complications emerge, physicians may perform PCI earlier.

5. CABG

• CABG may be used instead of PCI or thrombolytics for acute coronary syndrome. CABG may be used for patients who are unable to receive thrombolytic medications due to bleeding issues, recent strokes, or major surgeries.
• CABG may be used for patients who are unable to have PCI due to the severity of coronary artery disease (for example, several sites of blockage or poor heart function, especially if they have diabetes).

6. General Measures

• Physical exertion, mental stress, and excitement all strain the heart; a heart attack survivor should rest and stay in a quiet room for a few days.
• Smoking is prohibited in hospitals, as it is a substantial risk factor for coronary artery disease. Another compelling reason to stop smoking is acute coronary syndrome.
• Stool softeners and mild laxatives can help avoid constipation without straining. Urinary catheters measure urine production or if the patient cannot pee.
• For severe anxiety that is causing heart strain, a low-dose antianxiety medication such as Lorazepam may be prescribed.
• Some patients require antidepressants.

7. Rehabilitation: Cardiac rehabilitation begins in the hospital.

• Staying in bed for more than two or three days deconditioned the body and may lead to despair and helplessness.
• Sitting in a chair, passive exercise, and reading is usually possible on the first day following a heart attack.
• By the second or third day, people are encouraged to walk to the toilet and engage in non-stressful activities.
• The individuals frequently return to normal activities within six weeks. Regular exercise is beneficial to one's age and heart health.

Conclusion:

Young ACS patients have several critical differences to consider, such as sedentary behavior being the biggest risk factor. Male sex is the main non-modifiable risk factor among young adults; they most often have STEMI ACS. Young adults can modify risk variables, including smoking, oral tobacco use, hypertension, diabetes, dyslipidemia, and nutrition, along with obesity and a family history of premature CAD is also common in young ischemic patients. Three or more risk variables predispose to ACS at a younger age. These patients prioritize lifestyle improvement. Young ACS patients with timely management have good hospital outcomes.