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To determine what’s causing your symptoms, a doctor will take a careful medical history and give you a physical examination. If the doctor suspects an acute coronary syndrome, the following tests will be performed:

A doctor will give you a physical exam and ask about your symptoms and past health. He or she also will ask about your family’s health. You will have several tests to find out what is causing your symptoms.

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An electrocardiogram can show whether you have angina or have had a heart attack. This test measures the electrical signals that control your heart’s rhythm. Small pads or patches will be taped to your chest and other areas of your body. They connect to a machine that traces the signals onto paper. The doctor will look for certain changes on the graph to see if your heart is not getting enough blood or if you are having a heart attack.

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A blood test will look for a rise in cardiac enzymes. The heart releases these substances when it is damaged.
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In some cases, you might have a test called a cardiac perfusion scan to see if your heart is getting enough blood. It also can be used to check for areas of damage  after a heart attack.

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If tests confirm blood flow to the heart has been blocked, doctors will work quickly to reopen the artery.



The majority of cases are due to there being some narrowing in the blood vessels supplying the heart. This is usually due to the presence of some atheroma within the lining of the artery. Atheroma is like fatty patches or plaques that develop within the inside lining of arteries. (This is similar to water pipes that get furred up.)

Plaques of atheroma may gradually form over a number of years in one or more places in the coronary arteries. Each plaque has an outer firm shell with a soft inner fatty core. Atheroma leads to the blood vessels narrowing.
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Various other uncommon conditions can also block a coronary artery.

For example:

Inflammation of the coronary arteries (rare).

A blood clot forming elsewhere in the body (for example, in a heart chamber) and travelling to a coronary artery where it gets stuck.

Complications from heart surgery.

A stab wound to the heart.

Taking cocaine, which can cause a coronary artery to go into spasm.

Some other rare heart problems.

Chest pain caused by acute coronary syndromes can come on suddenly, as is the case with a heart attack. Other times, the pain can be unpredictable or get worse even with rest, both hallmark symptoms of unstable angina. People who experience chronic chest pain resulting from years of cholesterol buildup in their arteries can develop an acute coronary syndrome if a blood clot forms on
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What causes acute coronary syndrome?

Acute coronary syndrome happens because blood flow has slowed or stopped in the arteries that supply blood to the heart. Acute coronary syndrome is typically caused by coronary artery diseaseCoronary artery disease, also called heart disease, is caused by atherosclerosis, or hardening of the arteries.

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Atherosclerosis causes a substance called plaque to build up in the coronary arteries. Plaque causes angina by narrowing the arteries. The narrowing limits blood flow to the heart muscle. A heart attack happens when blood flow is completely blocked.



ACS ranges from a heart attack (myocardial infarction) to unstable angina.

Heart attack (myocardial infarction)

If you have a heart attack, a coronary artery or one of its smaller branches is suddenly blocked. The part of the heart muscle supplied by this artery loses its blood (and oxygen) supply. This part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word infarction means death of some tissue due to a blocked artery which stops blood from getting past.) In addition to being known as a heart attack, a myocardial infarction is sometimes called a coronary thrombosis.

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Three types of angina:

Stable angina

Unstable angina

Variant angina

Classic angina

Crescendo angina

Prinzmetal angina

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Unstable angina

Unstable angina occurs when the blood clot causes a reduced blood flow but not a total blockage. This means that the heart muscle supplied by the affected artery does not die (infarct).



The term ‘acute coronary syndrome’ covers a range of disorders, including a heart attack (myocardial infarction) and unstable angina, that are caused by the same underlying problem.
The underlying problem is a sudden reduction of blood flow to part of the heart muscle. This is usually caused by a blood clot that forms on a patch of atheroma within a coronary artery.

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The types of problems range from unstable angina to an actual myocardial infarction. In unstable angina a blood clot causes reduced blood flow but not a total blockage.

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Therefore, the heart muscle supplied by the affected artery does not die (infarct). The location of the blockage, the length of time that blood flow is blocked and the amount of damage that occurs determine the type of ACS.