SANU R 1ST YEAR MSC NURSING KIMS COLLEGE OF NURSING

ACUTE CORONARY SYNDROME

ACUTE CORONARY SYNDROME

Acute coronary syndrome usually occurs as a result of one on three problems, STEMIand NSTEMI,unstable angina, and elevated serum cardiac markers .

MYOCARDIAL INFRACTION
AMI is also know as heart attack, coronary occlusion, or simply a coronary, characterized by the formation of localized necrotic areas with in the myocardium. The sudden occlusion of a coronary artery and abrupt cessation of blood and oxygen flow to the heart.

UNSTABLE ANGINA
Unstable angina is a paroxysmal chest pain triggered by predictable degree of exertion or emotion ,which may occur at night. It attacks characteristically increase in number, duration, and severity over time.

ETIOLOGY

Thrombus partially or intermittently occludes the coronary artery.

NON MODIFICABLE RISK FACTORS

Hereditary/ Family history Increasing age Gender

MODIFICABLE RISK FACTORS

Smoking Hypertension Elevated serum cholesterol levels Obesity Diabetes mellitus Physical inactivity Alcoholism Oral contraceptive pills Response to stress Inflammatory responses

ANATOMY AND PHYSIOLOGY

BLOOD SUPPLY OF THE HEART

NERVE SUPPLY OF THE HEART

CONDUCTION SYSTEM OF THE HEART

Change in condition of the plaque in the coronary artery Activation of platelet

PATHOPHYSIOLOGY

Formation of thrombus

ischemia
Coronary blood supply less than demand Myocardial cell death Decreased contractibility

Altered depolarization of myocardium Release of lysosomal enzyme Anaerobic glycosis Myocardial irritability

ST Elevation Elevated CPKMB,TROPONI N I&T Lactic acid production dysrhythmias angina

Decreased irritability
Stimulation of sympathetic nervous system

Decreased left ventricular function

Increased heart rate Increased O2 needs Increased after load

Increased preload

Decreased cardiac output

Increased CVP&PC WP

Decreased LV function

vasoconstriction

CLINICAL MANIFESTATIONS

Chest pain Dyspnoea Diaphoresis Nausea and vomiting Palpitations Fatigue and lethargy Syncope Anxiety Abdominal pain fever

DIAGNOSTIC MEASURES
History collection Electrocardiogram findings Laboratory test (serum cardiac makers) CK MB Myoglobin Troponin LDH Leukocytosis Coronary angiography

CONT
Position emission tomography Magnetic resonance imaging Echocardiography Tran esophageal echocardiography Chest x-ray

ECG CHANGES

COMPLICATIONS
Dysrhythmias Heart

failure Cardiogenic shock Pulmonary embolism Pericarditis Recurrent myocardial infarction Ventricular aneurysm Papillary muscle dysfunction Dressler syndrome

MEDICAL MANAGEMENT
Goals of medical management Initiating prompt care Reducing pain Delivering successful treatment for the accute pain and reperfusion of the myocardium Preventing complications Rehabilitating and educating the client and significant others

EMERGENT PCI

It is recommended as the first line of treatment for patients with confirmed MI

DRUG THERAPY
IV nitroglycerin Morphine sulphate adrenergic blockers Angiotensin converting enzyme inhibitors Antidysrhythmic Drugs Cholesterol- lowering drugs Stool softners Nutritional therapy

INVASIVE CORONARY ARTERY PROCEDURES

Percutaneous transluminal coronary angioplasty(PTCA) Directional coronary atherectomy (DCA) Intracoronary stents Laser ablation Trans myocardial revascularization

PTCA

Thank you.