Acute Coronary Syndrome

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Acute Coronary Syndrome
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Acute Coronary Syndrome (ACS)

• Definition of ACS
• Signs and symptoms of ACS
• Gender and age related difference in ACS
• Pathophysiology of ACS
• Treatment of ACS
• Protocol For the Patient Experiencing Chest
  Pain

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Worldwide Statistics

• Each year
• gt 4 million patients are admitted with unstable
  angina and acute MI
• gt 900,000 patients undergo PTCA with or without
  stent
• From 1 to 4 percent of patients ultimately proven
  to have acute coronary syndrome are sent home
  from the emergency department.
• Only about 2 percent of patients with
  cocaine-associated chest pain have acute coronary
  syndrome.

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What is Acute Coronary Syndrome (ACS) ?

• Umbrella term used to cover a group of clinical
  symptoms compatible with acute myocardial
  ischemia
• Stable Angina (chest pain with activity)
• Unstable Angina (Chest pain with activity or
  rest)
• Myocardial Infarction with positive EKG (ST
  elevation MI STEMI)
• Myocardial Infarction with normal EKG (Non-ST
  segment elevation MI non-STEMI)

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Acute Coronary Syndrome

• Ischemic DiscomfortUnstable Symptoms

HistoryPhysical Exam
No ST-segmentelevation
ST-segmentelevation
ECG
AcuteReperfusion
Unstable Non-Q Q-Waveangina AMI AMI
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What happens during ACS?

• Atherosclerotic plaque ruptures and precipitates
  thrombus formation

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Acute Coronary Syndrome
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Risk Factors for ACS

• History of CAD
• Family history of CAD
• High blood pressure
• Age
• Men gt 33 yrs old
• Women gt 40 yrs old
• Blood vessel disease

• Diabetes
• Smoking
• Overweight
• High Cholesterol
• Menopausal
• No exercise

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Symptoms of ACS

• Chest pain or chest discomfort
• Indigestion
• Fainting
• Nausea and vomiting
• Pain in arms, shoulders, neck, back or jaw
• Pain in abdomen
• Shortness of breath
• Sweating
• Weakness

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Gender Differences in ACS

• Women verses Men
• Women are usually older and with more
  co-morbidities, such diabetes and hypertension
  when ACS occurs
• Women may have atypical chest pain
• Women have more shortness of breath, fatigue,
  nausea, back and neck discomfort than men

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Gender Differences (cont)

• Women seek medical care later than men
• Women seem to be evaluated less intensively than
  men
• Stress testing is less specific in women than
  men, with higher false positives in women

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Diabetes and ACS

• Patients are older, more often women
• Patients are at increased risk for heart / renal
  failure, cardiogenic shock and death
• Pain perception may be altered due to neuropathy

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Treatment of ACS
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Medical Management of ACS
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What if your patient has Chest Pain?Inpatient

• Stay at the patients bedside and summons help
• Assess patient and vital signs
• Implement the protocol, For the Patient
  Experiencing Chest Pain

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For The Patient Experiencing Chest Pain
CHESTPAIN Protocol

• Notify Rapid Response team by calling 8263.
• STAT EKG, CK Total, CKMB, Troponin1.
• Saline lock if no IV access.
• After EKG obtained, NTG 0.4 mg SL q5 minutes up
  to 3 tabs prn for chest pain. Hold if systolic
  B/P lt100.
• Nasal O2 at 2LPM, titrate to keep O2 saturation
  90 or greater.
• Notify physician of current assessment, vital
  signs and above actions taken. Have patient
  chart, current medication list and labs available
  when calling physician.
• Nurse should not delay calling the attending
  physician because of waiting on lab results.

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