Acute coronary syndrome: Symptoms and treatments

Acute Coronary Syndrome or ACS in short is a condition of the heart which occurs due to inadequate supply of oxygenated blood to the heart musculature. The cause for such an event would be a rupture of a cholesterol plaque and the exposed surface gives rise to platelet aggregation and formation of a thrombus or a blood clot. The event will take place suddenly, thus is named acute. The usual patients might be suffering already from angina and will feel a sudden worsening of the symptoms.

Accordingly there are three types of progression of ACS based on clinical and investigation findings. These are names Unstable Angina, ST elevation Myocardial Infarction and Non ST elevation Myocardial Infarction.

A patient with ACS will complain of following symptoms:

• Angina pain: typically this will be a described as tightening, burning or pricking kind of pain and will last for several minutes. It even appears at rest and following exertion due to exercise, heavy meal or stress.


• Referred pain: the pain will be noticed in the left shoulder or towards the left jaw and would be described as a shooting pain.


• Shortness of breath


• Nausea


• Light-headedness


• Associated sudden heavy sweating is also noticed

Following making a clinical diagnosis the treatment should follow quickly and this will have enormous contribution towards improving the mortality of such patients. There are several treatment options available, one such option is medical management.

Medicines:

Aspirin: Aspirin will act on the platelets and prevents the clots being formed and thus alleviating further complications through dislodging of such clots if allowed to form.

Thrombolytics: These drugs will help in the process of dissolving the platelet clots which are already formed and the earliest it is administered the better the outcome and chances of survival.

Nitroglycerines: These would act on the blood vessels by dilating the circumference and releasing any pressures from against which the heart has to pump. Therefore, it puts the heart at ease.

Beta blockers: It will relax the heart muscle, slow the heart rate and reduce the blood pressure. ACE inhibitors: These also will make the heart pump blood more easily.

Surgery: 

When medical treatment options are no longer doing the job or is not effective based on the level of narrowing of the blood vessels, a surgical option would be more suitable. At present two options are widely in use.

Dilatation and stenting: In this procedure a tiny wire will be inserted through an artery of the arm or the leg and guided towards the heart and reaches the blocked segment of the coronary artery. Upon arrival a balloon will be inflated and a supporting stent will be places in that position which will support the vessel walls and prevent narrowing again.

Bypass surgery: When this procedure is undertaken, a different route will be made through open surgery using a leg vein and thus bypassing the narrowed segment of the coronary artery.

Apart from the above mentioned acute management, the patient should have a healthy balanced diet which is low in fat. They also need to be engaged in healthy practices of living by avoiding smoking and other harmful habits. Regular exercises will also help in the long term care of these patients.

Survival "Excellent" Following Living Donor Liver Transplantation For Acute Liver Failure

Patients in Japan who underwent living donor liver transplantation (LDLT) for acute liver failure (ALF) were classified as having excellent outcomes, with ten-year survival at 73%. The findings, published in the September issue of Liver Transplantation, a journal of the American Association for the Study of Liver Diseases (AASLD), suggest that the type of liver disease or treatment plan does not affect long-term patient survival following LDLT. Donor and patient age, however, does impact long-term outcome post-transplant.

According to the AASLD, roughly 2,000 Americans develop ALF-formally called fulminant hepatitis-each year, with many of these cases caused by acetaminophen (Tylenol) overdose, drug-induced liver injury, autoimmune liver disease, or viral hepatitis. Previous studies report patient survival from ALF was less than 15% before the era of liver transplantation and significantly better at more than 65% following transplantation.

LDLT-when a portion of a healthy liver from a living donor is used for transplantation-was developed as an alternative treatment option to overcome the shortage of deceased donor organs. A 2007 study by de Villa et al. found that LDLT accounts for less than 5% of liver transplants in the U.S. and Europe compared to more than 90% in Asia excluding mainland China.

“ALF is a rare, life-threatening condition where the rapid deterioration of liver function causes changes in mental activity and disrupts the body’s blood clotting capabilities,” explains lead author Dr. Yasuhiko Sugawara, Associate Professor in the Graduate School of Medicine at the University of Tokyo in Japan. “Expanding knowledge of treatment options, such as LDLT, that improve patient outcome is imperative.”

Using data from the Intractable Liver Disease Study Group of Japan, researchers identified 209 ALF candidates who underwent living donor liver transplantation. The authors report that in patients who underwent LDLT the cumulative one-year, five-year and ten-year survival rates following transplantation were 79%, 74%, 73%, respectively. Patient age impacted short-term and long-term mortality, while donor age only affected long-term patient mortality.

“Our study demonstrates the benefit of LDLT in a Japanese population, which has less access to deceased donor organs,” concludes Dr. Sugawara. “Prospective studies are needed to determine the overall impact of LDLT in all patients with ALF.”

In a related editorial also published in Liver Transplantation, Professor Chung-Mau Lo with the University of Hong Kong and Queen Mary Hospital in Hong Kong, China, notes that LDLT for ALF patients has generated debate among experts in several areas: (1) reports in Western countries of inferior outcome with LDLT in high-urgency situations; (2) likelihood of ALF patients receiving a liver in countries with developed deceased organ donation programs; and (3) concern with coercion of donors and a possible increase of donor risk when the evaluation process is rushed in such an urgent situation.

“Deceased donor liver transplantation is dictated by the availability of the organ, and high-risk marginal grafts are frequently used. LDLT allows for early transplant to avoid waitlist mortality and better timing of the operation, which can be performed at the first sign of patient deterioration,” concludes Professor Lo. “LDLT for ALF has developed in Asia because there is no choice. Is it possible that it may in fact be a better choice?”