Acute Coronary Syndrome PDF

CARDIOVASCULAR SYSTEM CARDIOVASCULAR SYSTEM Cardiac Disorders Acute Coronary Syndrome — Emergent situation — Acute onset of myocardial ischemia -> myocardial death (e.g. MI) — Spectrum: vUnstable Angina vNSTEMI vSTEMI Myocardial infarction —The death of myocardial cells from inad...

CARDIOVASCULAR SYSTEM CARDIOVASCULAR SYSTEM Cardiac Disorders Acute Coronary Syndrome — Emergent situation — Acute onset of myocardial ischemia -> myocardial death (e.g. MI) — Spectrum: vUnstable Angina vNSTEMI vSTEMI Myocardial infarction —The death of myocardial cells from inadequate oxygenation, often caused by a sudden complete blockage of a coronary artery Pathophysiology — Unstable angina — Reduced blood flow in a coronary artery — Clot formation on top of the coronary lesion Ø Artery not completely occluded Pathophysiology — Myocardial Infarction — Plaque rupture & subsequent thrombus formation — Complete occlusion of the artery — Ischemia and necrosis — Area of infarction – minutes to hours Assessment findings: 1. Chest pain — severe, persistent, crushing substernal discomfort — radiates to the neck, arm, jaw and back — occurs without cause, primarily early morning — unrelieved by rest and nitroglycerine — last 30 minutes or more Assessment findings: 2. Dyspnea 3. Diaphoresis 4. Cold clammy skin 5. Nausea and vomiting 6. Restlessness 7. Hypotension Assessment and Diagnostic Findings — Presenting symptoms + 12-L ECG and Laboratory Tests — Prognosis – severity of obstruction/myocardial damage — Patient History Ø Description of presenting symptom Ø Previous cardiac and other illnesses — Family History — Personal-Social History Ø Risk factors Laboratory findings: 1. Elevated myocardial enzymes — CK-MB, LDH and Troponin 2. ECG — T wave inversion — ST segment elevation — Presence of abnormal Q wave Laboratory & Diagnostic Findings — Echocardiogram PEvaluate ventricular function PHypokinetic and akinetic wall motion — Troponin — CK-MB — Myoglobin Diagnosis — Unstable Angina P Clinical manifestations of coronary ischemia P (-) Evidence in ECG & cardiac biomarkers — STEMI P (+) ECG evidence – characteristic changes in 2 contiguous leads — NSTEMI P Elevated cardiac biomarkers P (-) definite ECG evidence Medical Management — Goals: — Minimize myocardial damage — Preserve myocardial function — Prevent complications — Initial Management — Supplemental O2 — Aspirin, NTG, and Morphine — Beta-blocker – introduced within 24 hours — Unfractionated heparin or LMWH  Emergent Percutaneous Coronary Intervention — Open occluded coronary artery — Promote reperfusion — Preferred initial treatment method — Door-to-balloon time = < 60 minutes Thrombolytics — Initiated when primary PCI not available or transport time to a PCI-capable hospital is too long — Alteplase, Reteplase, and Tenecteplase (given via IV) — Dissolve the thrombus — Does not affect the underlying atherosclerotic lesion — CI: Bleeding and bleeding disorder — Door-to-needle time = within 30 minutes Inpatient Management — Continuous cardiac monitoring — Continuing pharmacologic management P Aspirin P Beta-blocker P ACE inhibitors or ARB — BP — UO — Serum Na, K, and Crea level — Nicotine replacement therapy & tobacco cessation counseling Nursing management: 1. Administer O2 as ordered 2. Administer medications: — Morphine — Thrombolytics — Aspirin — Anticoagulant — Stool softeners 3. Provide bed rest in semi- fowler’s position 4. Minimize anxiety 5. Monitor ECG 6. Instruct pt to avoid constipation (suppositories) 7. Assist in treatment modalities — PTCA and CABG 8. Minimize metabolic demands — Provide soft diet — Provide a low-sodium, low cholesterol and low fat diet THANK YOU