Acute Coronary Syndrome (ACS) PDF

Dr. Rebar Yahya Abdullah ACUTE CORONARY SYNDROME (ACS) Lecturer Dr. Rebar Yahya Abdullah PhD. Family and community health  ACS Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the hea...

Dr. Rebar Yahya Abdullah ACUTE CORONARY SYNDROME (ACS) Lecturer Dr. Rebar Yahya Abdullah PhD. Family and community health  ACS Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue Dr. Rebar Yahya Abdullah Signs and symptoms Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw Nausea or vomiting Indigestion Shortness of breath (dyspnea) Sudden, heavy sweating (diaphoresis) Lightheadedness, dizziness or fainting Unusual or unexplained fatigue Feeling restless or apprehensive Dr. Rebar Yahya Abdullah  Risk factors People who suffer stress Aging High blood pressure High blood cholesterol Cigarette smoking Lack of physical activity Unhealthy diet Obesity or overweight Diabetes Family history of chest pain, heart disease or stroke History of high blood pressure, preeclampsia or diabetes during pregnancy COVID-19 infection Dr. Rebar Yahya Abdullah Relationships Among CAD, Stable Angina, and MI Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah  Patients in CCU Coronary disease patients  – Acute coronary syndrome (ACS) ST elevated MI (STEMI) Non-ST elevated MI (NSTEMI) Unstable angina  Chronic CAD with active cardiac problem Heart failure Arrhythmic problem – Post PCI/ post CABG Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah  Laboratory Tests  Creatine Kinase ) CK-MB(  Troponin. (troponin T and troponin I)  Troponin test result ranges  In healthy adults, the reference range (expected level) of troponin is very low or undetectable.  according to the American Board of Internal Medicine, are measured in nanograms per milliliter (ng/mL). They are:  Troponin I: 0 - 0.04 ng/mL.  Troponin T: 0 - 0.01 ng/mL. Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah  Cholesterol test Triglycerides Blood glucose LFT RFT CBC S. electrolytes(potassium ,calicuim,mg,na ,Ph) High-sensitivity C-reactive protein Electrocardiogram (ECG) Coronary Angiography Stress test ( also called treadmill or exercise ECG). TSH.T3 T4 Echocardiogram (also known as echo). Dr. Rebar Yahya Abdullah  Treatment Aspirin and clopidogrel: which helps to prevent blood clots forming. Anti coagulants: heparin ,warfarin, clexan Nitroglycerin : vasodilator A beta-blocker : to slow the heart rate, lower blood pressure.(LoL) Analgesic: morphine ,pethidine, tramadole A statin drug : to lower the level of cholesterol and other blood lipids in your blood. (Atrovastatin,simvastatin,rosuvastatin,fluvastatin) Dr. Rebar Yahya Abdullah  Anti hypertensive drug (captoprile,isordile,lisinoprile..)(ile) Diuretics(Lasix) Thrombolytic(actilyse) Antacid drugs (omeprazol.pantoprazol,esmoprazol (Nexium) lansoprazol..)(zol) Anti Diabetic drugs(metphormine acid.insulin inj..) Dopamine and dobutamine Stool softener (laxatives) such as Cascara Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah  Dr. Rebar Yahya Abdullah Actilyse Protocol 15 ml bolus Iv 50 ml infusion /30 min 35 ml Infusion /60 min  Surgery and other procedures PCI. In this procedure, your doctor inserts a long, tiny tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, opening the artery by compressing the plaque deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. Coronary bypass surgery. With this procedure, a surgeon takes a piece of blood vessel (graft) from another part of your body and creates a new route for blood that goes around (bypasses) a blocked coronary artery. Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah  Nursing Care and managements O2 2 cannula Semi-setting position Vital signs Rest and comfort Pain relievers(morphine, pethidine, tramadole). ECG Investigations(Troponin,CK.MB,S.electrolytes,RBS,CBC,Lipid.profile, RFT,T3,T4,TSH, Monitor Drug administration Psychological support. Immobility during 24-72 hours Dr. Rebar Yahya Abdullah  O2 Dr. Rebar Yahya Abdullah Semi Sitting Position Dr. Rebar Yahya Abdullah Vital Signs Dr. Rebar Yahya Abdullah  ECG Dr. Rebar Yahya Abdullah Investigation Dr. Rebar Yahya Abdullah Monitor Dr. Rebar Yahya Abdullah  Practical scenario Group discussion and working Nursing care for new admitted person who have heart attack Dr. Rebar Yahya Abdullah  health education Nutritional Therapy – Diet restricted in saturated fats and cholesterol – Low sodium If prescribed nitroglycerin, educate on routes, usage, storage, and side effects Dr. Rebar Yahya Abdullah  Description A Coronary Care Unit (CCU) is a specially staffed and equipped section of a healthcare facility for the support, monitoring and treatment of highly dependent patients with medical or surgical cardiac conditions which are life threatening or potentially life-threatening. Patients in CCU will include adults of all ages, acuity, frailty and all levels of disability. CCU is also increasingly dealing with patients with co- morbidities such as obesity, diabetes and renal dysfunctions Dr. Rebar Yahya Abdullah  What is the CCU? The CCU cares for patients who have: chest pain heart failure heart rhythm problems heart attack breathing problems as a result of heart problems heart infection or fluid around the heart (Cardiac tamponade, Infective endocarditis had a recent angiography or angioplasty  Patients are in the CCU so that they can be closely watched 24 hours a day. Dr. Rebar Yahya Abdullah  Cardiomyopathy : Ischemic & non-ischemic Severe valvular heart disease Cardiogenic shock Tachyarrhythmia : AF, SVT,VT disturbance, sinus pause/arrest Dr. Rebar Yahya Abdullah Monitor Dr. Rebar Yahya Abdullah ECG Device Dr. Rebar Yahya Abdullah DC Shock Dr. Rebar Yahya Abdullah  ANGINA WHAT TO DO Call 122 for emergency help. Help the person to stop what he is doing and sit down. Make sure that he is comfortable and reassure him; this should help the pain to ease. If the person has angina medication, such as tablets or a pump- action or aerosol spray, let him administer it himself. If necessary, help him to take it. Dr. Rebar Yahya Abdullah  Encourage the person to rest, and keep any bystanders away. Dr. Rebar Yahya Abdullah  MI Call 122 for emergency help. Tell ambulance control that you suspect a heart attack. Make the casualty as comfortable as possible to ease the strain on his heart. A half-sitting position, with his head and shoulders supported and his knees bent, is often best. Place cushions behind him and under his knees. Assist the person to take one full dose aspirin tablet (300mg in total). Advise him to chew it slowly. Dr. Rebar Yahya Abdullah  If the person has angina medication, such as tablets or a pump- action or aerosol spray, let him administer it; help him if necessary. Encourage him to rest. Monitor and record vital signs – breathing, pulse and level of response – while waiting for help to arrive. Stay calm to avoid undue stress May you encourage him to cough Avoid giving any food, fluids or stimulants such as alcohol, cigarettes, tea or coffee. Dr. Rebar Yahya Abdullah Begin CPR if the person is unconscious. If the person isn't breathing or you don't find a pulse, begin CPR to keep blood flowing after you call for emergency medical help. If an automated external defibrillator (AED) is immediately available and the person is unconscious, follow the device instructions for using it. Dr. Rebar Yahya Abdullah  caution If the casualty becomes unresponsive, open the airway and check breathing (The unresponsive person. Do not give the casualty aspirin if you know that he is allergic to it or if he is under 16 years of age. Dr. Rebar Yahya Abdullah Dr. Rebar Yahya Abdullah