Acute coronary syndrome result from a sudden blockage in a coronary artery. this blockage causes unstable angina or heart attack (MI), depending on the location and amount of blockage. people who experience an ACS usually have chest pressure or ache, shortness of breath and fatigue. People who think they are experiencing ACS should call for emergency help. Doctors use ECG and blood test (troponin level) to determine whether a person is experiencing an ACS. Treatment varies depending on the type of syndrome but usually include attempts to increase blood flow to affected area.

1. Acute Coronary
Syndrome
Jamilah saad Alqahtani
CNS,MSN,NS,RGN,BSN, OR Specialist

2. Outlines
• Introduction
• Definition
• Anatomy
• Pathophysiology
• Risk factors
• Symptoms
• Test and diagnosis
• Treatment
• complications
• Prevention
• PT education
• Summary
• Nursing process
• Referrnces
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3. Introduction
• Acute coronary syndrome a common complication of
coronary heart disease is associated with more than 2.5
million hospitalization world wide each year.
• According to WHO, cardiovascular diseases will the
leading cause of morbidity and mortality by the year
2020 and developing countries will be a major
contributes to this diseases.
• The overall prevalence of CAD in Saudi Arabia has been
reported to be 5.5% data regarding clinical presentation
and management of KSA patients with ACS are still
lacking.
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4. Definition
• Acute coronary syndrome is
an umbrella term for situations
where there is marked
narrowing or complete
blockage the blood supply to
the heart muscle is suddenly
it includes heart attack
(myocardial infraction)or
unstable angina.
• This is an absolute medical
emergency
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5. Anatomy
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6. Pathophysiology
• A heart muscle needs O2 to
survive a heart attack occurs
when the blood flow that
brings O2 to the heart muscle
is severely reduced as cut off
completely. This happens
because coronary arteries that
supply the heart muscle with
blood flow slowly become
narrow from a buildup of fat,
cholesterol and other
substance that together are
called plaque.
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7. Pathophysiology
• This slaw process is known as
atherosclerosis when a plaque
in a heart artery breaks a blood
clot forms around the plaque
this blood clot can black the
blood flow through heart
muscle. When the heart muscle
is starved for O2and nutrients,
it is called ischemia when
damage or death of part of the
heart muscle occurs as result of
ischemia . It is called a heart
attack or myocardial infarction
MI.
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8. Cont’d
• Atherosclerosis has no symptoms . One reason there
may be no warning signs is that sometimes when
coronary artery become narrowed other nearby
vessels that also bring blood to the heart sometimes
expand to help compensate. The network of
expanded vessels is called collateral circulation and
helps protect some people from heart attacks by
getting needed blood to the heart. Collateral
circulation can also develop after
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9. Risk factors
Modifiable Unmodifiable
• Dyslipidemia
• Smoking
• DM
• HTN, obesity, lack of
exercises
• High alcohol
consumption
• Age
• Sex
• Positive family history
ACS are much more likely in people who have certain risk factors .
These include:
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10. SYMPTOMS
• Chest pain
• SOB
• Feeling dizzy or light headed
• Nausea
• Vomiting
• Sudden, heavy sweating (diaphoresis
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11. Chest pain (angina pain)
• Quality/severity
anginal pain described as a squeezing, dull aching pain or
compressing or buring.is never stitching or throbbing pain.
It is variable intensity.
• Site/Radiation
 It is mostly substernal radiating to it arm sometimes to root
of neck both arms, shoulders, back, epigastrium, jaw, never
under the left breast.
 The pain may be associated with sweating, anxiety,
tachycardia, hypotension.
• Precipitating/Relieving factors
Physical exertion, extremes of weathers, emotional stress/rest,
Rest/sublingual nitrates.
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12. Chest pain location
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13. Tests and Diagnosis
• ECG
• Chest X-ray
• ECHO
• CT angiogram
• Angiogram
• Stress test
• Blood tests
• Nuclear scan
• Cardiac Catheterization
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14. ECG
• Unstable angina
• Non ST elevation MI
• ST elevation MI
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16. 12 leads ECG
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17. Lab tests
1. Elevation of cardiac enzymes
Creatinine kinase-myocardial
bound chloride (CK-MB,
troponin)both enzymes being to
elevate after 4hours. CK-MB
peaks in 24hr return to normal 2-
3 days but troponin 5-7 days.
2. ABG, CBC, electrolytes, LFT,
baseline of PT,PTT.
3. C-reactive protein, fibrinogen,
lipoprotein, triglycerides.
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18. Troponin test
 A troponin test measures the
levels troponin T or troponin
I proteins in the blood. These
proteins are released when
the heart muscle has been
damaged, such as occurs
with a heart attack. The more
damage there is to the heart,
the greater the amount of
troponin T and I there will be
in the blood.
 How the Test is Performed
A blood sample is needed.
And How to Prepare for the
Test
No special steps are needed to
prepare, most of the time.
 Why the Test is Performed
The most common reason to perform
this test is to see if a heart attack has
occurred. Your doctor will order this test
if you have chest pain and other signs of
a heart attack. The test is usually
repeated two more times over the next 6
to 24 hours.
Normal Results
Cardiac troponin levels are normally so
low they cannot be detected with most
blood tests.
Having normal troponin levels 12 hours
after chest pain has started means a
heart attack is unlikely.
A normal value range may vary slightly
among different laboratories. Some labs
use different measurements or test
different samples. Also, some labs have
different cutoff points for "normal" and
"probable myocardial infarction."
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19. Cardiac catheterization
• Definition: it is a diagnostic procedure performed by
running a radiopaque from agroin/femoral artery or
femoral vein to the heart guided by flouroscopy.
• An actual X-ray picture is created showing the course of
and any narrowing of coronary arteries.
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20. Cardiac catheterization
• Important of catheterization
1. One of the most useful and accurate tools to
diagnosing cardio vasculas problem
2. Can detect where arteries are narrowed or blocked.
3. Can measure blood pressure with in the heart and O2
in the blood.
4. Can evaluate heart muscle functions
5. Helps determine best course of treatment.
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21. Cardiac catheterization
• Risk of cardiac catheterization :
Usually cardiac catheterization is very safe.
A some number of people have minor problems. Some
develop bruises where the catheter had been inserted
(puncture site). The contrast dye that makes arteries show
up on X-rays causes some people to feel sick to their
stomach, get itchy or develop hives.
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22. Treatment
• General treatment
1. Hospitalization, O2 therapy, bed rest.
2. Acute phase treatment of ACS includes a
combination of anti-ischaemic and anti-
thrombotic agents with coronary
reperfusion achieved using fibrinolysis and
revascularization percutaneous coronary
intervention (PCI) or coronary artery
bypass graft(CABG) surgery.
3. Antiplatelet and anticoagulant agent are
routinely used during the acute phase of
ACS treatment. e.g. asprin(ASA) and
clapidagel(antiplatelet). Anticoagulant: low
molecular weight heparin.
4. Nitroglycerin (vasodilator)
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23. Cont’d
• Adjunctive therapy
Other agents recommended for use in
secondary prevention of ACS.
1. B-blackers: are effective especially when
tachycardia is present.
2. Calcium entry blockers: Diltazem, verpamil
are perfered as no reflex tachycardia or
hypotension (if b-blockers are
inappropriate and without Lt ventricular
dysfunction).
3. Statin: to mintain LDL cholesterol level at
<100mg/dl.
4. ACE inhibitor, antgiotensin receptor
bloackers, nitrates and Asprine.
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24. Cont’d
• Symptomatic treatment:
1. Morphine sulfate; for
pain relief.
2. antiemetic;
metoclopromide.
3. Emergent angioplasty
may be considered if
readily available or if
thrombolysis fails PCI.
• Treatment of
complication:
1. Digitalis for heart
failure.
2. Anti arrhythmic drugs.
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25. Percutaneous Coronary
Intervention PCI
• Method to unblock coronary arteries
without using surgery.
• Includes angioplasty and stent
insertion
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26. Angioplasty
• Cardiologist or (radiologist)
inserts catheter tube with small,
deflated balloon around it into
the coronary artery
• Balloon is expanded with liquid
which pushes the plaque to sides
of artery
• Balloon catheter removed
adequate size of artery restored
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27. Stent
• Types of stents include
 Bare metal
 Drug eluting
• Required medications
 ASA (aspirin)
Clopidogrel(plavix)
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28. Medication
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32. Complications
• Numerous complications can occur and increase morbidity
and mortality. They can be roughly categorized as
1. Ischemia complications (angina, re infraction)
2. Electrical dysfunction (conduction disturbance,
arrhythmias)like (atrial or ventricular arrhythmia, sinus or
atrio-ventercular dysfunction)
3. Mechanical dysfunction (heart failure, myocardial rupture or
aneurysm, papillary muscle dysfunction)
4. Embolic complications (central nervous system or peripheral
embolization)
5. Inflammatory complications (pericarditis, Dressler
syndrome)
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33. Prevention
• The goal of secondary prevention strategies after ACS
are two fold:
1. Prevention of thrombus formation and
recurrence.
2. Management of underling disorders. ex,
hypertension, DM, dyslipidemia and other risk
factors by medical and other means.
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34. Patient Education
• Teach
pt how
to
prevent
and
manage
stress
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35. Summary
• Acute coronary syndrome result from a sudden blockage in a
coronary artery. this blockage causes unstable angina or heart
attack (MI), depending on the location and amount of
blockage.
• people who experience an ACS usually have chest pressure
or ache, shortness of breath and fatigue.
• People who think they are experiencing ACS should call for
emergency help.
• Doctors use ECG and blood test (troponin level) to determine
whether a person is experiencing an ACS.
• Treatment varies depending on the type of syndrome but
usually include attempts to increase blood flow to affected
area.
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37. Nursing process
Work together as groups and create NCP for PT with ACS.
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38. References
• http://www.thrombosisadviser.com/en/acs/a-leading-
cause-of-
mortality/?WT.cusCampaignVendor=AdWords&WT.cusC
ampaignChannel=g&WT.cusCampaignAd=4860856515
&WT.cusCampaignKeyword=acute%20coronary%20syn
drome&WT.cusCampaignAdGrp=ACS&WT.cusCMP=asi
a&WT.cusMT=p&gclid=CjwKEAjw5NihBRCZmdLkuuTHy
WYSJACtCY0JNzjlnTM-
j2X2Im1EzxDyDBrjB__BUWO1W4ypc5WhMBoCkfbw_w
cB
• http://www.nlm.nih.gov/medlineplus/ency/article/007452.
htm
• http://en.wikipedia.org/wiki/Troponin
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