Acute coronary syndrome is a term that encompasses both unstable angina and myocardial infarction (MI). It is characterized by new-onset or rapidly worsening angina (crescendo angina), angina on minimal exertion or angina at rest in the absence of myocardial damage. In contrast, MI occurs when symptoms occur at rest and there is evidence of myocardial necrosis, as demonstrated by an elevation in cardiac troponin or creatine kinase-MB isoenzyme.

An acute coronary syndrome may present as a new phenomenon or against a background of chronic stable angina. The culprit lesion is usually a complex ulcerated or fissured atheromatous plaque with adherent platelet-rich thrombus and local coronary artery spasm. This is a dynamic process whereby the degree of obstruction may either increase, leading to complete vessel occlusion, or regress due to the effects of platelet disaggregation and endogenous occurs, it is usually due to an arrhythmia or profound hypotension.

RISK FACTOR:

The risk factors for acute coronary syndrome are the same as those for other types of heart disease. Acute coronary syndrome risk factors include:

• Aging
• High blood pressure
• High blood cholesterol
• Cigarette smoking
• Lack of physical activity
• Unhealthy diet
• Obesity or overweight
• Diabetes
• Family history of chest pain, heart disease or stroke
• History of high blood pressure, preeclampsia or diabetes during pregnancy
• COVID-19 infection

CLINICAL FEATURES:

The signs and symptoms of acute coronary syndrome usually begin abruptly. They include:

• Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning
• Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
• Nausea or vomiting
• Indigestion
• Shortness of breath (dyspnea)
• Sudden, heavy sweating (diaphoresis)
• Lightheadedness, dizziness or fainting
• Unusual or unexplained fatigue
• Feeling restless or apprehensive
• Vomiting and sinus bradycardia are often due to vagal stimulation and are particularly common in patients with inferior MI.
• Sometimes infarction occurs in the absence of physical signs.
• Sudden death, from ventricular fibrillation or asystole, may occur immediately and often within the first hour. If the patient survives this most critical stage, the liability to dangerous arrhythmias remains, but diminishes as each hour goes by. It is vital that patients know not to delay calling for help if symptoms occur. The development of cardiac failure reflects the extent of myocardial ischaemia and is the major cause of death in those who survive the first few hours.

HOMOEOPATHIC TREATMENT

CACTUS GRANDIFLORIS: – Constriction; whole body feels as if caged, with wire being twisted tighter and tighter.  Heart feels as if clasped and unclapsed rapidly by an iron hand. very acute pains and stitches in heart; pulse feeble, irregular, quick, without strength. Heart weakness of arterio-sclerosis. Violent palpitation; worse lying on left side.

CRATAEGUS: – Said to have a solvent power upon crustaceous and calcareous deposits in arteries. For artherosclerosis and cardiac dropsy. Extreme dyspnoea on least exertion. Pulse irregular, feeble, intermittent.

CUPRUM METALLICUM – Angina pectoris. Slow pulse; or hard, full and quick. Palpitation, praecordial anxiety and pain. Fatty degeneration.

LACHESIS- Constricted feeling causing palpitation, with anxiety. Palpitation, with fainting spells, especially during climacteric. Irregular beats.

CROTALUS HORRIDUS – Heart’s action ceases suddenly, impending suffocation. Trembling feeling of heart. Action feeble, pulse tremulous.

OXALICUM ACIDUM – Heart symptoms alternate with aphonia, angina pectoris; sharp, lancinating pain in left lung coming on suddenly, depriving of breath. Praecordial pains which dart to the left shoulder. Palpitation and dyspnoea in organic heart disease; worse, when thinking of it.

DIGITALIS –  the pulse is weak, irregular, intermittent, abnormally slow.  Great weakness and sinking of strength, faintness, coldness of skin, and irregular respiration; Stimulates the heart’s muscle. Pulse weak, and quickened by least movement. The least movement causes violent palpitation, and sensation as if it would cease beating, if he moves.

NAJA TRIPUDIANS – Its action settles around the heart; valvular troubles. Hypertrophy, and valvular lesions. Angina pains extending to nape of neck, left shoulder and arm with anxiety and fear of death. Pulse irregular in force. Acute and chronic endocarditis. Palpitation.

AMYL NITROSUM – Praecordial anxiety. Pain and constriction around heart. Fluttering at slightest excitement. Palpitation of the heart and especially the flushing and other discomforts at climacteric. On inhaling this drug, it rapidly dilates all arterioles and capillaries, producing flushing

ADONIS VERNALIS. – muscles of the heart are in stage of fatty degeneration, regulate the pulse and increase the power of contractions of heart. Low vitality, with weak heart and slow, weak pulse. Mitral and aortic regurgitation. Myocarditis, irregular cardiac action, constriction and vertigo. Praecordial pain, palpitation, and dyspnoea.

TABACUM – Should prove the most homoeopathic drug for angina pectoris, with coronaritis and high tension (Cartier). Angina pectoris, pain in praecordial region. Palpitation when lying on left side. pain in praecordial region. Pain radiates from center of sternum. Acute dilatation caused by shock or violent physical exertion (Royal). Tachycardia. Bradycardia.