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What causes acute coronary syndrome (ACS)?

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 disease. Coronary 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.

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