Key Patient Messages: 2025 Acute Coronary Syndromes Guideline

Published: February 27, 2025

When the blood flow to the heart is suddenly slowed or stopped this is called Acute Coronary Syndrome (ACS). Several health conditions can lead to ACS. This includes atherosclerosis, which is a buildup of fatty deposits (plaque) in the coronary arteries. When a piece of plaque breaks off, it can block blood flow and cause a heart attack also known as myocardial infarction (MI).
Recognizing the signs of a heart attack (PDF) are useful to act quickly and get help. This picture shows some common symptoms. Other symptoms include sweating and a rapid heartbeat or palpitations.

Women may also experience symptoms like upper back pressure, anxiety, upset stomach, and unusual tiredness and weakness.
Below are some of the questions, decisions, and information the clinician is thinking about when treating a patient who is experiencing a heart attack.

Vital signs
What is the patient's blood pressure, breathing rate, bodytemperature, and pulse rate?

How is the heart working at that moment
This will help determine the best and safest treatment.

Timing of symptoms and treatment
Different treatments need to be started within a certain amount of time to work best.

Type of heart problem
Clinicians need to determine if the patient is having a heart attack, cardiac arrest or other health problem to give the right treatment.

Overall health
Other health conditions could change which medicines or procedures the patient needs.

Tests and procedures needed
This could include:

Electrocardiogram or “ECG” which records the electrical activity of the heart and can show signs of a heart attack
Blood tests
Echocardiogram or “echo” which is an ultrasound that takes pictures of the heart
Cardiac Catheterization (cardiac cath) or angiography which is a procedure where dye is injected into the heart arteries to diagnose the heart problem)
Cardiac CT or MRI which can provide detailed pictures of the heart and can assess heart damage

There are key differences between a heart attack and cardiac arrest. A heart attack is when the blood flow to the heart is stopped or partially blocked. There are two types of heart attacks, called STEMI and non-STEMI.

ST-Elevation Myocardial Infarction (STEMI) Heart Attack
This is when the blood flow is completely blocked.

Non ST-Elevation Myocardial Infarction (Non-STEMI) Heart Attack
This is when the blood flow is partially blocked.

A cardiac arrest is when there are problems with the heart rhythm that change how the heart beats, called arrhythmias. A heart attack can cause a cardiac arrest to happen. There are many different types of cardiac arrest.

The clinician may send the patient to the Cardiac-Catheterization Lab, often called the “Cath Lab,” for a common procedure called an angiogram when they are experiencing ACS. In the Cath lab, a clinician can look inside the heart arteries for blockages and at how the patient’s heart is working at that moment to diagnose or treat the heart problem.

It’s helpful to understand the following about the Cath Lab:
- Both routine and emergency medical care can be given in the Cath Lab.
- Not all patients will need emergency care in the Cath Lab.
  - The patient may need other safe and effective treatments that cannot be given in the Cath Lab.

There are many ways to treat a heart attack. The treatment will depend on the type of heart problem the patient has and what caused that problem.

Listed below are some common treatments, which include medicines and surgical procedures. These treatments work to restore blood flow back to the heart, stop or prevent blood clots, or restore a normal heart rhythm.

Common Treatments - Medications
Common Medications	What to Know About These Medications
Antithrombotic therapy	These are medicines that help prevent blood clots.
Anticoagulant	This is a type of antithrombotic medicine. These medicines are often called blood thinners and delay the body’s ability to clot blood.
Antiplatelet	This is a type of antithrombotic therapy. These medicines keep blood platelets from sticking together that can cause a blood clot. Taking two types of these medicines is called dual antiplatelet therapy (DAPT).
Statins	These medicines help lower cholesterol that can cause blockages in the arteries and reduce blood flow to the heart.
Beta-blockers	These medicines help treat heart rhythm problems and lower blood pressure.
ACE inhibitors	These medicines help lower blood pressure.

Common Treatments - Surgical Procedures
Common Surgical Procedures	What to Know About These Surgical Procedures
Percutaneous Coronary Intervention (PCI)	This surgical procedure usually happens in the Cath Lab. The clinician opens a narrowed or blocked artery, often with a very small balloon which is called angioplasty, and may place a stent that will keep the artery from becoming blocked again.
Coronary Artery Bypass Surgery (CABG) (PDF)	This procedure happens in the operating room instead of the Cath lab. During this procedure, the clinician takes blood vessels from another part of the body to create new places for blood to flow. This lets the blood flow around the blocked or narrowed heart arteries and reach the heart.
Implantable Cardioverter-Defibrillator (ICD)	This surgical procedure usually happens in the Cath Lab but can also be done in the operating room. During this surgical procedure, a device is implanted under the skin to track the patient’s heart rate. It can detect an abnormal heart rhythm and send an electric shock to restore the rhythm.

Patients that receive Cardiac Rehabilitation after a heart attack or cardiac arrest have the best survival rates, strongest recovery, and less chance of returning to the hospital. This type of program has a team of clinicians that offer personal and monitored exercise training, health and nutrition education, psychological support, patient assessment and help taking medications in the most effective way.
- Patients can be referred to cardiac rehabilitation while they are still recovering in the hospital or after they leave the hospital. There are some home-based options for patients that live too far away from a cardiac rehabilitation center. Patients should ask their clinician about how to receive these services.
  
  In most cases, health insurance will pay for cardiac rehabilitation sessions, including Medicare. Patients can call their health insurance provider to ask for more information:
  - Does their condition qualify them for these services?
  - How many sessions will be covered?
  - Where can they receive those services?
It’s important to know that a second heart attack can be prevented with lifestyle changes. Learning about Life's Essential 8 can help.
Focusing on overall wellbeing and mental health is important after experiencing a heart attack. Mental health support and support networks like those found here at the American Heart Association can help patients connect with others who have experienced this life changing event.
Learn how to help someone experiencing a heart attack. The first step is to act quickly and call 911. If someone is experiencing a cardiac arrest, CPR can help keep the blood flowing to the heart until medical care is available. Watch this 60 second video to learn how to do hands-only CPR.

There is also a machine that can help someone’s heart beat after a cardiac arrest called an AED, automated external defibrillator (AED).

The AED gives voice prompts that say exactly what to do, so that whoever is using the machine does not have to worry about harming someone. Anyone can learn to use an AED.