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Acute Coronary Syndrome

The acute phase of coronary disease can develop in a matter of seconds.

It involves spontaneous rupture of a cholesterol blockage (plaque) and the development of thrombus (blood clot) which compromises blood flow and can quickly result in heart damage.

Frequently it can first manifest itself as sudden death.

Image source: NHBLI

Click here to see how a fatal heart attack happens.

When a vulnerable atherosclerotic plaque ruptures, material is released into the bloodstream and causes the blood to clot.

The degree of clot can restrict blood flow ranging from mildly limiting  to complete total occlusion.

The severity of the acute coronary syndrome depends on how much flow is restricted.

Image source: Clotbuster Archives.

Above is is a histological section of a ruptured plaque with the presence of blood clot.

Image source : medicalmyths.word.com

Image source: Clotbuster Archives.

On the left, the arrow points to a lipid plaque in the left coronary artery.

On the right, the arrow shows that the lipid plaque has ruptured and formed blood clot  (thrombus).

Image source : Clotbuster Archives.

The arrow above points to a long blood clot (thrombus) in the middle portion of the left anterior descending artery (LAD), the coronary artery that supplies the front part of the heart with blood.


Image source: Clotbuster Archives.

This causes a large area 
of muscle damage (infarction) in the front and tip of the left ventricle (arrow).

degree to which thrombus forms determines which of the 3 acute coronary syndromes will be manifested.

If there is minimal thrombus,
unstable angina will occur.

If the thrombus is moderate, the result will be a 
non - STEMI.

If  there is total occlusion a  
STEMI will occur.

In an Acute Coronary Syndrome, the alteration in blood flow to the heart can cause a characteristic change in the EKG, more specifically, in the ST segment

If blood flow is cut off completely, as it is in a full -blow heart attack, the ST segments will elevate. As a result this kind of heart attack has been named a STEMI or ST elevation Myocardial Infarction. 

If the interruption of blood flow is partial, i.e. a mini-heart attack or unstable angina, then the ST segments become depressed or you can see inversion of the T wave portion. This type of acute coronary syndrome is called
a non-STEMI or non- ST elevation Myocardial Infarction.