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What is Acute Coronary Syndrome, or ACS? It’s when your heart muscle isn’t getting enough blood and oxygen—usually because one of your coronary arteries becomes blocked or narrowed. Think of it like a clogged pipe that can’t deliver what the heart needs. The most common cause is something called plaque rupture. This is when fatty buildup inside the artery suddenly breaks open, triggering a blood clot that blocks blood flow. Another cause is plaque erosion, where the inner lining of the artery