Acute Coronary
Syndrome
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”
Worldwide Statistics
Each year:
• > 4 million patients are admitted with unstable angina
and acute MI
• > 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 cocaineassociated chest pain have acute coronary
syndrome.
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)
Acute Coronary Syndrome
Ischemic Discomfort
Unstable Symptoms
No ST-segment
elevation
Unstable
angina
History
Physical Exam
ST-segment
elevation
Non-Q
AMI
Q-Wave
AMI
ECG
Acute
Reperfusion
What happens during ACS?
Atherosclerotic plaque ruptures and precipitates
thrombus formation
Acute Coronary Syndrome
Risk Factors for ACS
•
•
•
•
History of CAD
Family history of CAD
High blood pressure
Age:
Men > 33 yrs old
Women > 40 yrs old
• Blood vessel disease
•
•
•
•
Diabetes
Smoking
Overweight
High
Cholesterol
• Menopausal
• No exercise
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
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
Gender Differences (con’t)
• 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
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
Treatment of ACS
Medical Management of ACS
What if your patient has Chest Pain?
Inpatient
• Stay at the patient’s bedside and
summons help
• Assess patient and vital signs
• Implement the protocol, “For the Patient
Experiencing Chest Pain”
For The Patient Experiencing Chest Pain
[CHESTPAIN] Protocol
1.
2.
3.
4.
5.
6.
7.
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 <100.
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.
Any questions?
www.somc.org
Safety  Quality  Service  Relationships  Performance