Acute coronary syndrome

A group of disorders characterized by changes in coronary circulation, their common feature being the reduction or cessation of blood flow in the coronary arteries.
The two most important reasons for determining the occurrence of ACS are "unstable plaque" and thrombogenic factors.


Classification of ACS:

  • Unstable angina (UA)/non-ST elevation myocardial infarction (NSTEMI)
  • ST elevation myocardial infarction (STEMI) – corresponds to the term ‘myocardial infarction’
  • Sudden cardiac death (the most critical form of heart attack).


The difference between UA and NSTEMI is determined by the indicators of myocardial necrosis; currently, this is the level of troponin (UA – ACS negative troponin, NSTEMI – ACS positive troponin).

Myocardial infarction

Cardiac cell necrosis caused by prolonged myocardial ischaemia. Ischaemia is the result of an imbalance between the release of blood and demand.

Stable or unstable angina may lead to a heart attack.

Risk factors:

  • High cholesterol
  • Hypertension
  • Diabetes
  • Obesity
  • Smoking.


Signs and symptoms:

  • Retrosternal pain (over 30 min) radiating to the left upper limb, neck, jaw and covering the entire front part of the chest; may appear in the upper abdomen (a feeling of high-intensity burning, choking, cramping). It is important that it persists after taking nitroglycerin.
  • Shortness of breath
  • Nausea, vomiting
  • Dizziness
  • Increased sweating
  • Fear and anxiety
  • Pallor
  • Sticky sweat
  • Palpitations
  • Swelling (in patients with hypertension)

Frequent circumstances:

  • Stress
  • Effort
  • Temperature fluctuations

Stable angina

This condition occurs when the heart receives enough blood to sustain normal functions, but not enough to meet the body's needs during physical exertion or emotional excitement.
Discomfort takes a few minutes and is relieved by rest and nitroglycerin.