Acute Coronary Syndromes and Primary PCI

Acute coronary syndromes, including heart attacks, happen when blood flow to part of the heart muscle is suddenly reduced or blocked. Rapid treatment saves heart muscle and lives. Primary PCI is emergency angioplasty to reopen the blocked artery.

A heart attack is a medical emergency: call 1122
Acute coronary syndromes include unstable angina, NSTEMI and STEMI
Primary PCI reopens the blocked artery as quickly as possible
Treated in hospitals with a cardiac catheterisation laboratory
Recovery includes medicines, rehabilitation and risk-factor control

In an emergency, do not wait. If you have severe chest pain, severe breathlessness, fainting, or other symptoms of a possible heart attack or medical emergency, call 1122 or go to the nearest emergency department immediately. Do not wait for a clinic or online appointment.

The clinic number and WhatsApp are for appointments and non-emergency queries only.

Recognise the warning signs

chest pain, pressure, heaviness or tightness, often lasting more than a few minutes
pain spreading to the arms, neck, jaw, back or upper abdomen
breathlessness, sweating, nausea or light-headedness

Women, older people and people with diabetes may have less typical symptoms. Call 1122 or go straight to the nearest emergency department. Avoid driving yourself, and do not wait to see whether the symptoms pass. Read more about heart attack warning signs.

Heart Attack Mein Kya Karein? 5 Galtiyan Bilkul Na Karein | Heart Attack Symptoms & First Aid

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What is an acute coronary syndrome?

Most acute coronary syndromes happen when a fatty plaque in a heart artery breaks open and a blood clot forms on it, suddenly reducing or blocking blood flow. They include:

unstable angina: new or worsening chest pain without detectable heart muscle damage
NSTEMI: a heart attack with heart muscle damage, usually from a partly blocked artery
STEMI: a heart attack usually caused by a completely blocked artery, with a characteristic ECG pattern

Diagnosis relies on symptoms, the ECG and a blood test called troponin. A single normal ECG does not always rule out a heart attack, so repeat ECGs and blood tests are often needed.

What is primary PCI?

For STEMI, international guidelines recommend primary PCI as the preferred treatment: emergency angioplasty to reopen the blocked artery as soon as possible after diagnosis, carried out by an experienced team. When primary PCI cannot be delivered in time, a clot-dissolving medicine (thrombolysis) may be given first, followed by angiography.

For NSTEMI and unstable angina, angiography is often recommended, with the timing based on how high-risk the situation is.

Why time matters

Heart muscle starts to be damaged soon after an artery becomes blocked. The sooner blood flow is restored, the more heart muscle can be saved. This is why calling 1122 promptly matters more than anything else.

After a heart attack

Recovery usually includes medicines that protect the heart (such as antiplatelets and statins, with others as appropriate), cardiac rehabilitation where available, a gradual return to activity and control of risk factors. Regular follow-up with a cardiologist helps reduce the chance of another event. See life after a stent and preventive cardiology.

Questions patients ask

Can I message the clinic on WhatsApp if I have chest pain?

No. Chest pain that could be a heart attack is an emergency. Call 1122 or go to the nearest emergency department.

What is the difference between a heart attack and a cardiac arrest?

A heart attack is caused by a blocked heart artery that damages heart muscle. A cardiac arrest is when the heart suddenly stops pumping effectively, usually because of a dangerous heart rhythm. A heart attack can lead to a cardiac arrest.

Is primary PCI always possible?

It depends on how quickly a hospital with a cardiac catheterisation laboratory can be reached. If primary PCI cannot be delivered in time, clot-dissolving treatment may be given first.

References

Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720–3826. doi.org/10.1093/eurheartj/ehad191 (opens in a new tab)
Rao SV, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation 2025;151:e771–e862. doi.org/10.1161/CIR.0000000000001309 (opens in a new tab)

This page is general information about the condition or procedure, not personal medical advice. Whether a test or treatment is right for you is decided at your consultation. Medical disclaimer.

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Clinic at Rawalpindi Institute of Cardiology (RIC), Room 8. Monday to Friday, 3:00 PM to 8:00 PM. Call or WhatsApp +92 307 5793387.