Acute Coronary Syndrome

1. Acute Coronary Syndrome

2. 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”

3. 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 cocaine-associated chest pain have acute coronary syndrome.

4. 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)

5. Acute Coronary Syndrome Ischemic DiscomfortUnstable Symptoms HistoryPhysical Exam No ST-segmentelevation ST-segmentelevation ECG AcuteReperfusion Unstable Non-Q Q-Waveangina AMI AMI

6. What happens during ACS? Atherosclerotic plaque ruptures and precipitates thrombus formation

7. Acute Coronary Syndrome

8. 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

9. 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

10. 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

11. 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

12. 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

13. Treatment of ACS

14. Medical Management of ACS

15. 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”

16. 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 <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.

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