Pace Hospitals | Best Hospitals in Hyderabad, Telangana, India
ACUTE CORONARY SYNDROME TREATMENT

Acute Coronary Syndrome Treatment in Hyderabad, India - Best Heart Care

PACE Hospitals is recognized as best Acute Coronary Syndrome treatment hospital in Hyderabad, Telangana, India, provides comprehensive ACS treatment, including advanced diagnostics, emergency care, angioplasty, stenting, and cardiac rehabilitation. Our expert cardiologists and cardiac surgeons ensure personalized treatment plans to improve heart health and prevent future complications.


Acute Coronary Syndrome (ACS) is a life-threatening condition caused by sudden blockage of blood flow to the heart, leading to heart attacks and unstable angina. If you are experiencing symptoms like chest pain, shortness of breath, dizziness, or nausea, immediate medical attention is crucial. Book an appointment with the best cardiologist in Hyderabad at PACE Hospitals for ACS treatment.

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Best Hospital for Acute Coronary Syndrome Treatment in Hyderabad, Telangana India | ACS Treatment near me
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Acute coronary syndrome diagnosis in Hyderabad, Telangana, India

Diagnosis and Evaluation of Acute Coronary Syndrome

The diagnosis is based on patient history, symptoms, electrocardiography findings, and cardiac biomarkers, which differentiate between ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). 


The cardiologist considers the following before selecting the appropriate tests to diagnose acute coronary syndrome:


🔷Initial evaluation 


  • Medical history: Complete and focused history taking is important both to assess the likelihood that the presenting illness is an acute coronary syndrome and to determine the presence of risk factors. History of coronary artery disease, diabetes, hypertension, male gender, older age, and smoking are some of the related factors that contribute to the identification of ischemia. 


  • Physical examination: Patients presenting with symptoms of chest pain to the emergency department need to be considered as high priority cases. During a physical examination, the physician identifies any precipitating causes of myocardial ischemia. Physical examination findings such as pale, cool skin; sinus tachycardia (a condition where the heartbeat is faster than normal); a third or fourth heart sound; and hypotension indicating a large area of ischemia.


🔷Diagnostic tests 


Based on the above information, the cardiologist may recommend the following tests to diagnose acute coronary syndrome: 

  • Laboratory testing 
  • Cardiac biomarkers 
  • Blood tests 
  • ECG
  • ECG and serial ECG
  • Imaging studies 
  • Echocardiography
  • Coronary angiography
  • Other tests 
  • Stress test
  • Myocardial imaging 
  • Right heart catheterization 


Laboratory testing


  • Cardiac biomarkers: In patients who present with symptoms of chest discomfort and other symptoms suggestive of acute coronary syndrome the levels of cardiac biomarkers are measured. Cardiac-specific troponins T and I measurement allow for accurate and specific determination of myocardial injury in the context of ischemic symptoms; CK – MB has been replaced by these troponins as the preferred marker for the detection of myocardial necrosis. Usually, troponin levels do not increase for at least 6 hours after the onset of symptoms, therefore the test has to be repeated 8 to 12 hours after the onset of symptoms. 


  • Blood tests: Apart from cardiac biomarkers a full lipid profile is suggested by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III within 24 hours of onset of acute coronary syndrome. A thyroid function test is suggested when a patient presents symptoms of acute coronary syndrome and has persistent tachycardia (a condition where the heartbeat is fast. Troponin levels are also measured.


ECG (Electrocardiography): It is the most important test and should be done within 10 minutes of hospitalization. For ST elevation myocardial infarction initial ECG is diagnostic which shows ST segment elevation greater than or equal to 1mm in leads extending the damaged area. When symptoms are characteristic the ST-segment elevation on ECG has a specificity of up to 94 percent and a sensitivity of up to 55 percent for diagnosing myocardial infarction. 


Serial ECG tracings, which can be obtained every 8 hours for 1 day and then daily show gradual progression toward a stable, normal pattern or the development of abnormal Q waves over a few days confirming the diagnosis.


Imaging studies


  • Echocardiography: It is an accurate, inexpensive, rapid, and noninvasive test that helps in detecting complications of acute coronary syndrome. It has diagnostic and prognostic value evaluating damaged myocardium and myocardium which is not involved with acute ischemia. It is the mainstay of diagnosis of mechanical complications of myocardial infarction which include ischemic mitral and tricuspid regurgitation, ventricular and papillary muscle rupture, LV thrombi (left ventricular thrombus), left ventricular aneurysms (a condition where heart muscle in the left ventricle gets stretched or thinned) and pseudoaneurysms (a condition where the blood leaks from blood vessel and arteries into the surrounding tissue). 


  • Coronary angiography: Coronary angiography combined with percutaneous coronary intervention, is used for immediate diagnosis after the onset of acute myocardial infarction. This approach has reduced morbidity and mortality and improved outcomes. It is obtained urgently for patients with ST elevation myocardial infarction (STEMI), in patients with chest pain despite maximal medical therapy, and in patients with complications. Patients with uncomplicated non-ST elevation myocardial infarction or unstable angina undergo angiography within the first 24 to 48 hours of hospitalization to identify lesions that may require treatment.


Other tests 

  • Stress testing: During stress testing the heart is monitored by imaging studies during an episode of increased cardiac demand in order to identify ischemic areas that are potentially at risk of infarction. It is less invasive and less expensive compared to cardiac catheterization and helps in detecting abnormalities of blood flow. The cardiac demand for stress testing is increased by exercise or by drugs (pharmacologic testing). In exercise stress testing the cardiac demand is increased by making the patient walk on a conventional treadmill, until the target heart rate is reached, or symptoms occur. In pharmacologic stress testing certain drugs are administered to patients to increase the cardiac demand and this test is recommended for patients who cannot walk on a treadmill long enough due to their health conditions. 


  • Myocardial imaging: It is not always necessary to make a diagnosis when a cardiac biomarker or ECG is positive. Individuals with symptoms of acute coronary syndrome (ACS) and normal cardiac biomarker levels may undergo stress imaging tests (radionuclide or echocardiographic imaging with pharmacologic or exercise stress). Abnormalities in imaging indicate an increased risk of complications in the next 3 to 6 months and suggest the need for angiography, which can be done before discharge or soon after the discharge, with PCI or CABG done as necessary.


  • Right heart catheterization: A ballon tipped pulmonary artery catheter is used to measure the right heart pressures, pulmonary artery occlusion pressure, and cardiac output. This test is recommended only in conditions where the patient has significant complications (heart failure, hypoxia, hypotension). 

✅ Acute coronary syndrome differential diagnosis

Many pathological entities can mimic acute coronary syndrome in both clinical presentation and ECG findings. In acute coronary syndrome, the differential diagnosis includes the following:


  • Anxiety disorder: It is a condition where the individual is excessively worried and has extreme fear or terror. Sweating, restlessness, irritability, poor concentration, rapid heartbeat, and dizziness are some of the common symptoms and these symptoms may get worse over time. 
  • Acute pericarditis: It is a condition where the pericardium (a thin saclike structure that surrounds the heart) is inflamed, it is caused by infections, trauma, heart attack, heart surgery, and kidney failure. 
  • Aortic stenosis: It is the narrowing of aortic valve, which blocks blood flow to the heart. It is characterized by symptoms of chest pain, shortness of breath, fatigue, palpitations, and fatigue. 
  • Dilated cardiomyopathy: It is a condition where the heart muscle gets weakened or gets stretched. It results in insufficient pumping of blood to various parts of the body. 
  • Asthma: It is a chronic inflammatory respiratory condition that is characterized by symptoms of intermittent dyspnea (shortness of breath), cough, and wheezing.
  • Myocarditis: It is a rare and serious condition where the myocardium (middle muscular layer of the heart) gets inflamed, thereby weakening the heart and disrupting its electrical activity. 
  • Esophagitis: It is a condition where the lining of the esophagus gets inflamed and is characterized by symptoms of chest pain, difficulty in swallowing, heartburn, and cough. 
  • Myocardial infarction: Also called a heart attack, is a medical emergency that occurs when blood flow to the heart is blocked, causing the heart muscle to die.

✅ Goals of treatment for acute coronary syndrome

Following are some of the primary aims of acute coronary syndrome treatment:


  • To provide relief from chest pain 
  • To provide adequate oxygen concentration
  • To initiate reperfusion therapy in order to reduce the extent of infarction 
  • To reduce complications of myocardial infarction 
  • To prevent further cardiac events
Best Treatment Options for Acute Coronary Syndrome in Hyderabad, Telangana, India

Acute coronary syndrome treatment

Treatment of acute coronary syndrome aims to reduce cardiac ischemia and to prevent death. Acute coronary syndrome management is based on the type and amount of blockage in the coronary artery. Treatment is as follows:


🔷Initial management


  • Antiplatelet therapy: It is the best treatment option for patients with acute coronary syndrome (ACS). It decreases the risk of thrombosis and its consequences includes death and myocardial infarction (MI). Pathophysiology of acute coronary syndrome (ACS) includes activation of platelets and aggregation in response to endothelial injury. Medications are divided into oral and parenteral drugs, with oral agents further divided on the basis of mechanism of action.


  • Anticoagulant therapy: Anticoagulation therapy combined with antiplatelet therapy is effective in the treatment of acute coronary syndromes (ACS). This combination therapy when used effectively, results in a reduction in recurrent ischemic events, including myocardial infarction and lowers the risk of death. Anticoagulation therapy with antiplatelet agents is more effective in decreasing recurrent thrombotic events in non-ST elevation acute coronary syndrome (NSTE-ACS) compared to monotherapy with antiplatelets. This is because of the inhibition of thrombin production and activity.


  • Nitrates: These are potent vasodilators that are used to increase coronary blood flow. It provides symptom relief and is given intravenously and sublingually. Short-acting nitrates are used to lower cardiac workload in selected patients. These medications dilate veins, arteries, and arterioles, reducing left ventricular preload and afterload. On long term the use may benefit patients with recurrent chest pain. Nitrates, when given in the first few hours reduce infarct size and possibly long-term mortality risk. They are not routinely given to low-risk patients with uncomplicated myocardial infarction (MI). 


  • Opioid: These are potent analgesics and are recommended for the relief of ischemic chest pain. Opioids are prescribed in patients with acute coronary syndrome in some conditions such as severe chest pain and increased sympathetic tone caused by acute coronary syndrome. They rapidly relieve symptoms and are now the mainstay in controlling ischemic pain. They have relatively fewer cardiovascular adverse effects compared to non-steroidal anti-inflammatory drugs which is the reason why opioids are used instead of other analgesics to deal with pain. 


  • Oxygen therapy: In both acute and chronic cardiac care, oxygen therapy is usually used. High flow oxygen is administered instantaneously in patients presenting with symptoms of chest pain. It was believed that oxygen therapy eases ischemia and angina pain. But high flow oxygen reduces cardiac output, attributes to vasoconstriction, and increases systemic vascular resistance. 


  • Beta blockers: Beta blockers are recommended especially in high-risk patients. They decrease heart rate, arterial pressure, and contractility, thereby reducing cardiac workload and oxygen demand. Beta blockers when given orally within the first few hours can improve the prognosis by decreasing the recurrence rate, incidence of ventricular fibrillation, and mortality risk. 


  • Statins: Many studies have indicated that with the use of statins, morbidity and mortality is decreased in patients with atherosclerosis. Statins inhibit different pathological pathways such as endothelial dysfunction, inflammatory and coagulation cascade activation, and thrombus formation which trigger acute coronary syndrome. They have long been used for preventing coronary artery disease (CAD) and acute coronary syndromes (ACS). 


🔷Revascularization procedures 


  • Percutaneous coronary intervention: It is a non-surgical procedure that is used to treat the blockages in a coronary artery; it restores blood flow to the heart by opening narrowed or blocked areas of the coronary artery. It is indicated in coronary artery disease (CAD), chronic total occlusion, acute coronary syndromes (ACS), and angina. A small tube or a sheath is inserted into the blood vessel of the wrist or groin. Then a catheter is placed within the sheath and guided through it to the heart. X-ray images help the physician guide the catheter through blood vessels until it reaches the damaged area of the coronary artery. Then a physician injects a contrast liquid into the artery. This liquid enables certain tissues visible more in X-rays, allowing physicians to determine where the coronary artery is narrowed or blocked. 


  • Coronary artery bypass grafting (CABG): It is a high-risk surgical procedure in the setting of acute coronary syndrome. It is a succession from unstable angina to non‐ST‐segment elevation myocardial infarction (NSTEMI) to ST‐segment elevation myocardial infarction (STEMI). This procedure is indicated in patients whose symptoms are refractory to medical therapy, hemodynamic instability, left main or triple vessel disease, or percutaneous coronary intervention not suitable or failed percutaneous coronary intervention.  In this procedure, the blocked portion of the coronary artery is bypassed with a section of a healthy blood vessel from the body. The healthy blood vessels may be pieces of a vein from the leg or an artery of the chest. The cardiologist may attach one end of the graft above the blockage and the other end below the blockage. Then blood bypasses the blockage through the new graft to reach the heart muscle and this is called coronary artery bypass surgery.


🔷Rehabilitation and Lifestyle modifications


  • Cardiac rehabilitation: These programs’ emphasizes on improving long-term outcomes and quality of life for acute coronary syndrome patients. Apart from physical exercise they also include lifestyle changes, risk factor management, and psychosocial care. These are performed in in-patient or outpatient settings and patient’s adherence to treatment and persistence in treatment have to be assessed. The rate of referral, participation in, and implementation of these programs is low despite proven benefits. 


  • Lifestyle changes: Adopting healthy lifestyle behaviors can improve cardiovascular health. Engaging in physical and social activities and personal activities play an important role in the recovery of acute coronary syndrome patients. Tobacco smoking cessation measures have to be initiated. Patients have to adopt a healthy heart diet that reduces cardiovascular disease risk. Limiting alcohol consumption is recommended and regular moderate aerobic exercise is recommended.

✅Acute coronary syndrome prognosis

Due to advancements in drug therapy and interventional techniques, there has been a rapid improvement in the prognosis of acute coronary syndrome patients. However, mortality remains substantially high despite recent advances in treatment. In acute coronary syndrome patients with or without heart failure, prognosis has shown to differ based on a medical or revascularization approach and is influenced by factors such as gender differences, physical activity, follow-up strategies, medications, and heart failure.


Acute coronary syndrome prognosis is based on the following:



  • How quick the treatment is done
  • The number of blocked arteries and the amount of blockage in the arteries 
  • Whether the heart is damaged, if damaged the extent of damage and the area of damage.

  • Is acute coronary syndrome curable?

    No, acute coronary syndrome is not curable as the damage to the heart cannot be reversed, but it can be managed with medications and with revascularization strategies, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). 

  • Who is more at risk for developing acute coronary syndrome?

    Individuals who are obese or overweight, with a family history of chest pain or heart disease, with medical conditions like high blood pressure, high cholesterol, and diabetes are at increased risk for developing acute coronary syndrome. 

  • Is acute coronary syndrome hereditary?

    Yes, acute coronary syndrome (ACS) can be hereditary. It is a complex multifactorial disorder that results from the close interaction between acquired and inherited risk factors.

  • Can stress cause Acute Coronary Syndrome (ACS)?

    Yes, psychological stress can lead to acute coronary syndrome. Acute coronary syndrome is an end result of a complex mechanism involving platelet activation and endothelial dysfunction and many studies have shown that mental stress can cause enhanced platelet activation and endothelial dysfunction.

Frequently Asked Questions (FAQs) on Acute Coronary Syndrome (ACS)

What is Acute Coronary Syndrome (ACS)?

It is a group of conditions in which the blood flow to the heart decreases. This group includes ST-elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. It results from coronary artery occlusion, which is due to the formation of a thrombus or a ruptured atherosclerotic plaque.

What is NSTEMI?

NSTEMI stands for non-ST elevation myocardial infarction. It is a pressure-like substernal pain, which occurs while at rest or during physical exertion. This pain usually lasts for more than 10 minutes, and it can travel to either the arm, neck, or jaw.

How common is Acute Coronary Syndrome (ACS)? 

It is a leading cause of morbidity and mortality worldwide. Every year, an estimated 12 lakh individuals in the U.S. are hospitalized with acute coronary syndrome (ACS). STEMI (ST -elevated myocardial infarction) accounts for about 30 percent of these hospitalizations, while NSTEMI (Non-ST elevated myocardial infarction) accounts for the remaining 70 percent of the cases.

What are the complications of Acute Coronary Syndrome (ACS)? 

Complications of acute coronary syndrome can be serious and life threatening. Arrhythmias and conduction abnormalities are the most common complications. Apart from these some other complications include heart failure, myocardial rupture, pericarditis, recurrent ischemia, and post myocardial infarction syndrome. 

What are the symptoms of Acute Coronary Syndrome (ACS)?

Discomfort or pain that feels like tightness, squeezing, crushing, burning, choking, or aching, shortness of breath (SOB), anxiety, nausea, sweating, dizziness or lightheaded, and irregular heartbeat are some of the symptoms of acute coronary syndrome.

What is the difference between CAD and ACS?

Acute coronary syndrome (ACS) is a subcategory of coronary artery disease (CAD). Coronary artery disease (CAD) is characterized by atherosclerosis in the coronary arteries and is asymptomatic whereas acute coronary syndrome always presents with a symptom and is associated with myocardial infarction.

Can hypertension cause Acute Coronary Syndrome (ACS)? 

Yes, hypertension can cause acute coronary syndrome. It is one of the primary factors that lead to atherogenesis and the formation of plaques which rupture and lead to the development of acute coronary syndrome. 

Is diabetes a risk factor for Acute Coronary Syndrome (ACS)?

Yes, diabetes is associated with an increased risk of developing acute coronary syndrome. It increases the progression of atherosclerosis. Higher levels of proinflammatory cytokines cause a decrease in collagen synthesis and an increased breakdown of collagen in the atherosclerotic plaque. These factors lead to the rupture of plague and thrombus formation thereby narrowing the coronary arteries. 

Which is the most serious Acute Coronary Syndrome (ACS)?

ST elevation myocardial infarction (STEMI) is the most serious type of acute coronary syndrome. It is a total blockage of the coronary artery which supplies oxygen rich blood to the heart muscle. In long term, this blockage of blood supply causes the death of the heart muscle and ultimately leads to heart failure and death.

What is the primary prevention for Acute Coronary Syndrome (ACS)? 

A healthy diet that includes fruits, vegetables, whole grains and lean meat. Limiting alcohol consumption and avoiding smoking are the primary prevention measures for acute coronary syndrome. Apart from diet, engaging in physical activities, and managing other health conditions like diabetes, and hypertension can help in preventing or reducing the progression of acute coronary syndrome.

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