Aerobic metabolism, the conversion of pyruvic acid to CO2 and H2O, accounts for the majority of the energy produced in cardiac muscles. When coronary arteries are unable to deliver enough oxygenated blood to myocytes, the patient develops acute coronary syndromes Hypoxia and at times anoxia result from diseases and conditions which lead to atherosclerosis that limits or impairs coronary blood flow. Risk factors include dyslipidemia, HTN, DM, hypothyroidism, diets high in fat and calories or low in fruits, vegetables, and vitamins E and C, stress, and sedentary life-style.
In at-risk patients, pharmacological strategies include the administration of antihyperlipidemic agents. To prevent acute coronary syndromes, calcium-channel blocking agents are administered to increase circulation in coronary arteries and β1‑adrenergic receptor antagonists are prescribed to reduce the workload. Non-pharmacological strategies include coronary artery bypass grafts or percutaneous coronary intervention (PCI), i.e., balloon angioplasty or stent implantation. Key recommendations for practice are presented in Table 12.