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”
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.
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
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
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