• Atherosclerosis, which is a build up of fat and cholesterol inside the arteries. This is the most common cause. The build up (plaque) can cause blood vessels in the heart (coronary arteries) to become narrow or blocked, reducing blood flow to the heart. Plaque can also break off and lead to a clot, which can block an artery and cause a heart attack or stroke.

• Sudden tightening of the muscles around the coronary arteries. This is called a coronary spasm.

• Tearing of a coronary artery (spontaneous coronary artery dissection).

• Very low blood pressure (hypotension).

• An abnormal heartbeat (arrhythmia).

• Other medical conditions that cause a decrease of oxygen to the heart, such as anaemiaorrespiratory failure.

• Using illegal drugs such as cocaine or methamphetamine.

• Age. The risk for ACS increases as you get older.

• Personal or family history of chest pain, heart attack, peripheral vascular disease, or stroke.

• Having taken chemotherapy or immune-suppressing medicines.

• Being male.

• Being overweight.

• Having any of these conditions:

  • High cholesterol.

  • High blood pressure (hypertension).

  • Diabetes.

• Lifestyle choices such as:

  • Excessive alcohol use.

  • Not exercising enough.

  • Smoking.

• Chest pain. The pain may last a long time, or it may stop and come back (recur). It may feel like:

  • Crushing or squeezing.

  • Tightness, pressure, fullness, or heaviness.

• Pain in the neck, arm, jaw or back.

• Heartburn or indigestion.

• Shortness of breath.

• Nausea.

• Sudden cold sweats.

• Light-headedness, dizziness, or passing out.

• Tiredness (fatigue).

• Your medical history and symptoms.

• Imaging tests, such as:

  • An electrocardiogram (ECG). This measures the heart’s electrical activity.

  • CT scan.

  • A coronary angiography. For this test, dye is injected into the heart arteries and then X-rays are taken.

  • Echocardiogram. This is a test that uses sound waves to produce an image of the heart.

• Blood tests to check for cardiac markers. These chemicals are released by a damaged heart muscle. These tests may be repeated at certain time intervals.

• Exercise stress testing.

• Medicines, such as:

  • Antiplatelet medicines that help prevent blood clots, such as aspirin or clopidogrel.

  • Medicine that dissolves any blood clots (fibrinolytic therapy).

  • Blood pressure medicines.

  • Nitroglycerin. This helps widen blood vessels to improve blood flow.

  • Painkillers.

  • Cholesterol-lowering medicine such as statins.

• Surgery, such as:

  • Coronary angioplasty with stent placement. This involves placing a small mesh tube (stent) into a narrow coronary artery. This widens the artery and keeps it open.

  • Coronary artery bypass surgery. This involves taking a section of a blood vessel from a different part of your body and placing it on the blocked coronary artery to allow blood to flow around the blockage.

• Cardiac rehabilitation. This is a programme that includes exercise training, education, and counselling to help you recover.

Medicines

• Take over-the-counter and prescription medicines only as instructed by your healthcare provider.

• Do not take these medicines unless your healthcare provider approves:

  • Any vitamins or supplements.

  • NSAIDs, such as ibuprofen, naproxen, or celecoxib.

  • Hormone replacement therapy that contains oestrogen.

• If you are taking blood thinners:

  • Talk with your healthcare provider before you take any medicines that contain aspirin or NSAIDs. These medicines increase your risk for dangerous bleeding.

  • Take your medicine exactly as instructed, at the same time every day.

  • Avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.

  • Wear a medical alert bracelet or carry a card that lists what medicines you take.

Eating and drinking

• Eat a heart-healthy diet that includes wholegrains, fruits and vegetables, lean proteins and low-fat or non-fat dairy products.

• Limit how much salt (sodium) you eat as instructed by your healthcare provider. Follow instructions from your healthcare provider about any other eating or drinking restrictions, such as limiting foods that are high in fat and processed sugars.

• Use healthy cooking methods such as roasting, grilling, broiling, baking, poaching, steaming, or stir-frying.

• Work with a dietitian to follow a heart-healthy eating plan.

Activity

• Follow your cardiac rehabilitation programme. Do exercises as instructed by your physiotherapist.

• Ask your healthcare provider what activities and exercises are safe for you. Follow his or her instructions about lifting, driving, or climbing stairs.

Lifestyle

• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco and vaping devices, such as e-cigarettes. If you need help quitting, ask your healthcare provider.

• Do not drink alcohol if:

  • Your healthcare provider tells you not to drink.

  • You are pregnant, may be pregnant, or are planning to become pregnant.

• If you drink alcohol:

  • Limit how much you have to:

    • 0–1 drink a day for women.

    • 0–2 drinks a day for men.

  • Know how much alcohol is in your drink.

• Maintain a healthy weight. If you need to lose weight, work with your healthcare provider to do so safely.

General instructions

• Tell all the healthcare providers who provide care for you about your heart condition, including your dentist. This may affect the medicines or treatment you receive.

• Manage any other health conditions you have, such as hypertension or diabetes. These conditions affect your heart.

• Pay attention to your mental health. You may be at higher risk for depression.

  • Find ways to manage stress.

  • Talk to your healthcare provider about depression screening and treatment.

• Keep your vaccinations up to date.

  • Get the flu jab (influenza vaccine) every year.

  • Get the pneumococcal vaccine if you are age 65 or older.

• If directed, monitor your blood pressure at home.

• Keep all follow-up appointments. This is important.