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Acute Coronary Syndrome
Prepared by:
Feroz khan
Sr. Clinical Nurse
Out Comes
1. To be able to differentiate heart attack and
muscular pain.
2. To understand about Acute Coronary
Syndrome.
3. To understand differences between unstable
angina vs NSTEMI vs STEMI.
4. To know risk factors and diagnostic tolls.
5. To know about treatment and management.
Acute Coronary Syndrome
“A spectrum of conditions resulting from
thrombus formation in the coronary arteries
following rupture of an atherosclerotic plaque”
Types of ACS
NSTEMI
ACS
STEMI
UA
Acute Coronary Cyndrome (ACS)
UN Unstable Angina
NSTEMI Non ST Elevation
Myocardial Infarction
STEMI ST elevation Myocardial
Infarction
Pathalogy
Aorta
Back flow towards
aortic valve during
diastole gives
coronary
perfusion
Pathology
Right Coronary
Artery (RCA)
 RA
 SA+AV nodes
 RV
Left Anterior
Descending(LAD)
 LV
 Intra
Ventricular
septum
 RV
Left Coronary
artery(LCA)
Left
circumflex(LCX)
 LA
 LV
Left Obtuse
Marginal(OM)
 LV
Pathology
Over time these arteries become
Atherosclerosis.
Which is the formation of fatty plaques on the
walls. Atherosclerosis plaques have a fibrous cap
which contains thrombogenic material;
Cell debris, lipids and inflammatory cell.
Pathology
Thrombogenic
Material (cell
debris, lipids,
inflammatory
cells
Fibrous Cap
Pathology
Atherosclerosis
Stable Angina
Acute reduced
blood flow
Clot formation
Ruptured
Fibrosis cap
Pathology
Severity of obstruction / Ischemia determines ACS
pathology
Unstable Angina NSTEMI STEMI
*No Necrosis *Partial Necrosis *Transmural
(Transmural: Existing or occurring across the entire wall of an organ or blood vessel).
Risk factors
Modifiable
1. Smoking
2. Hypertension
3. Diabetes
4. Hyperlipidemia
5. Obesity
6. Drug use eg; Cocaine
Non-Modifiable
1. Age
2. Male sex
3. Family History
4. Ethnicity
Signs and Symptoms
i. Chest pain /
Discomfort
ii. Back / Epigastric pain
iii. Light headiness
iv. Nausea /Vomiting
v. Diaphoresis
(Sweating)
vi. Palpitation
vii. Dyspnea
# It is possible to present
without chest pain
Female
Elderly
Diabetics
Diagnosis
1) ECG
STEMI
ST elevation
oST elevations ≥ 1mm IN 2 continuous leads
oIf In V2 + V3: ≥ 1.5mm IN Females
≥ 2mm IN Males
o New LBB
Diagnosis
1. 12 leads ECG
Anterior/Septal Lateral Interior
Left anterior Descending Left circumflex Right coronary
Diagnosis
1. 12 lead ECG
NSTE-ACS( NSTEMI+UA)
ST wave
ST Depression Inversion
 ST depression + T wave inversion
 Not representing of location
 Pathological Q wave not typical
 Isolated TWI are Post Ischemic
Diagnosis
1. 12 lead ECG
LBBB
*ST segment difficult to
interpret in LBBB
OR Paced Rhythm
Diagnosis
1. ECG
2. LAB investigations
– Cardiac Troponin I
– ≥ 99 Pecentile
– Rise from 2hrs
– Peak at 12-48 hrs
Diagnosis
1. ECG
2. LAB investigations
3. Coronary Angiography
4. C x R
5. Echocardiography
Treatment
General
– Morphine
– Oxygen
– Nitrates
– spirin
– Anti Emetics
Perfusion/
Reperfusion
– STEMI / High Risk
– Primary Percutaneous
intervention (≤ 90minutes)
– Fibrinolytics
• Tissue plasminogen activator
Eg : Altiplase
Rectiplase etc
Treatment
Medical
1. Anti Platelets
*P2Y12 Inhibators
eg; Ticagrelor/ clopidogril
2. Anti Coagulation
*IV Heparin
* SC LMWH (Low molecular heparin)
3. STATIN
4. ACEi / ARB
5. Beta Blocker
Nursing Interventions
Nurses caring for patients with ACS should have ;
ECG interpretation skills, as ECG changes or arrhythmias are signs
of potential deterioration.
Other elements of nursing care include ongoing management of
IV cannulas, central venous pressure lines, urinary catheters and
wounds and dressings.
It is the nature of the strong heart, that like the
palm tree it strives ever upwards when it is most
burdened. ...
Philip Sidney

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Acute Coronary Syndroms (ACS) by Feroz Khan RN.pptx

  • 1. Acute Coronary Syndrome Prepared by: Feroz khan Sr. Clinical Nurse
  • 2. Out Comes 1. To be able to differentiate heart attack and muscular pain. 2. To understand about Acute Coronary Syndrome. 3. To understand differences between unstable angina vs NSTEMI vs STEMI. 4. To know risk factors and diagnostic tolls. 5. To know about treatment and management.
  • 3. Acute Coronary Syndrome “A spectrum of conditions resulting from thrombus formation in the coronary arteries following rupture of an atherosclerotic plaque”
  • 5. Acute Coronary Cyndrome (ACS) UN Unstable Angina NSTEMI Non ST Elevation Myocardial Infarction STEMI ST elevation Myocardial Infarction
  • 6. Pathalogy Aorta Back flow towards aortic valve during diastole gives coronary perfusion
  • 7. Pathology Right Coronary Artery (RCA)  RA  SA+AV nodes  RV Left Anterior Descending(LAD)  LV  Intra Ventricular septum  RV Left Coronary artery(LCA) Left circumflex(LCX)  LA  LV Left Obtuse Marginal(OM)  LV
  • 8. Pathology Over time these arteries become Atherosclerosis. Which is the formation of fatty plaques on the walls. Atherosclerosis plaques have a fibrous cap which contains thrombogenic material; Cell debris, lipids and inflammatory cell.
  • 10. Pathology Atherosclerosis Stable Angina Acute reduced blood flow Clot formation Ruptured Fibrosis cap
  • 11. Pathology Severity of obstruction / Ischemia determines ACS pathology Unstable Angina NSTEMI STEMI *No Necrosis *Partial Necrosis *Transmural (Transmural: Existing or occurring across the entire wall of an organ or blood vessel).
  • 12. Risk factors Modifiable 1. Smoking 2. Hypertension 3. Diabetes 4. Hyperlipidemia 5. Obesity 6. Drug use eg; Cocaine Non-Modifiable 1. Age 2. Male sex 3. Family History 4. Ethnicity
  • 13. Signs and Symptoms i. Chest pain / Discomfort ii. Back / Epigastric pain iii. Light headiness iv. Nausea /Vomiting v. Diaphoresis (Sweating) vi. Palpitation vii. Dyspnea # It is possible to present without chest pain Female Elderly Diabetics
  • 14. Diagnosis 1) ECG STEMI ST elevation oST elevations ≥ 1mm IN 2 continuous leads oIf In V2 + V3: ≥ 1.5mm IN Females ≥ 2mm IN Males o New LBB
  • 15. Diagnosis 1. 12 leads ECG Anterior/Septal Lateral Interior Left anterior Descending Left circumflex Right coronary
  • 16. Diagnosis 1. 12 lead ECG NSTE-ACS( NSTEMI+UA) ST wave ST Depression Inversion  ST depression + T wave inversion  Not representing of location  Pathological Q wave not typical  Isolated TWI are Post Ischemic
  • 17. Diagnosis 1. 12 lead ECG LBBB *ST segment difficult to interpret in LBBB OR Paced Rhythm
  • 18. Diagnosis 1. ECG 2. LAB investigations – Cardiac Troponin I – ≥ 99 Pecentile – Rise from 2hrs – Peak at 12-48 hrs
  • 19. Diagnosis 1. ECG 2. LAB investigations 3. Coronary Angiography 4. C x R 5. Echocardiography
  • 20. Treatment General – Morphine – Oxygen – Nitrates – spirin – Anti Emetics Perfusion/ Reperfusion – STEMI / High Risk – Primary Percutaneous intervention (≤ 90minutes) – Fibrinolytics • Tissue plasminogen activator Eg : Altiplase Rectiplase etc
  • 21. Treatment Medical 1. Anti Platelets *P2Y12 Inhibators eg; Ticagrelor/ clopidogril 2. Anti Coagulation *IV Heparin * SC LMWH (Low molecular heparin) 3. STATIN 4. ACEi / ARB 5. Beta Blocker
  • 22. Nursing Interventions Nurses caring for patients with ACS should have ; ECG interpretation skills, as ECG changes or arrhythmias are signs of potential deterioration. Other elements of nursing care include ongoing management of IV cannulas, central venous pressure lines, urinary catheters and wounds and dressings.
  • 23. It is the nature of the strong heart, that like the palm tree it strives ever upwards when it is most burdened. ... Philip Sidney