acute coronary syndrome

Acute Coronary Syndrome

(ACS)

Acute Coronary SyndromeIt is believed that the atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregati0n,thrombus formation and vasoconstriction. ( Medical-Surgical Nursing by Agnatavicius and Workman.

Represents the spectrum of ischemic coronary disease ranging from unstable Angina through Myocardial Infarction.

Risk factors:

Precipitating factors:

Predisposing factors:

Sedentary lifestyle: SmokingHypertensionAlcohol Intake ObesityCaffeine IntakeDiabetes

Advanced AgeGender: Male

Race:African-American

Accumulation of Cholesterol that develops into hardened plaque (Atherosclerotic plaque)

Atherosclerotic plaque ruptures, fissures and ulcerated

Thrombus formation

Thrombus break-off

Occlude in smaller vessels like Coronary Arteries

Pathophysiology

Alteration of haemostatic and coagulation of pathways

Ineffective tissue perfusion

Unstable Angina

Myocardial Infarction

Decrease ventricular compliance

Decrease blood flow and oxygen supply in systemic circulation

Clinical manifestationRespiratory

systemSOBDyspnea

Chest painTachycardiaDysrythmias

Cardiovascular system

GI system

Nausea and VomitingEpigasric distress

Integumentary system

DiaphoresisSkin is moist, cool and pale

Neurologic system

Anxiety

Musculoskeletal system

RestlessnessFatigue and weakness

DIAGNOSTIC TESTElectrocardiography(ECG)

Twelve-lead electrocardiogram allow the health care provider to examine the heart from varying perspectives and to note both the occurrence and the location of Angina and Infarction.

Stress TestThe health care provider often orders an Exercise tolerance test (stress test) to assess for ECG changes consistent with ischemia, evaluation medical therapy, and identifies who might benefits from referral for invasive therapy.

Cont’.Myocardial Perfusion Imaging(MPI)

Thallium scans used radioisotope imaging to assess for ischemia or necrotic muscle tissue related to Angina or Myocardial Infarction (MI). Areas of decrease or absent perfusion, referred to as cold spots, identifies ischemia of infarction.

Magnetic Resonance Imaging (MRI)Contrast-enhanced cardiovascular Magnetic

Resonance Imaging (CMRI) may also be used as non-invasive approached to detect MI.

’Cont’. Cardiac catheterization

This procedure may be performed to determined the extent and exact location of obstruction of the coronary arteries. It allows the cardiologist and cardiac surgeon to identifies clients who might benefit from Percutaneous Transluminal Angioplasty (PCTA) or coronary artery bypass grafting (CABG).

Surgical Management

1. Percutaneous Transluminal Angioplasty Is an invasive procedure but non surgical

technique. It is performed to reduced the frequency and severity of discomfort for clients with Angina and to bridged clients with coronary bypass graft surgery.

2. Coronary Artery Bypass Graft Surgery Which occluded coronary arteries by passed

with client’s own artery blood vessels.

Cont’.

3. Minimally Invasive Direct Coronary Artery Bypass May be indicate for clients with a lesion of

the left anterior descending artery.4. Transmyocardial Laser Revascularization

A left thoracotomy is performed and the heart is visualized, a laser is used to create 20-24 long and narrow channels through left ventricular muscle to left ventricle.

Cont;.5. Robotics

Invasive open hear surgery Provides surgeon with capabilities that

simplify the surgical process, elimination of tremors that can exist with human hands, increase ability to reach inaccessible sites and improves depth perception and visual acuity

6. Off-Pump Coronary Artery Bypass It is a open heart surgery without the use of a

heart-lung bypass machine. Advantages include shorter hospital stays and decreased mortality, risk of infection and cost.

Medical Management

1. Nitroglycerin Increased collateral blood flow,

redistributes blood flow towards the subendocardium, and causes dilatation of coronary arteries.

2. Morphine Sulfate To relieve chest discomfort that is

unresponsive to niroglycerin. And it relieves MI pain, decreased myocardial oxygen demand, relaxes smooth muscles and reduces circulating catecholamine.

Cont’.3. Oxygen therapy

May increase the amount of oxygen available to myocardial tissue. Administered at a flow of 2-4L/min. by nasal cannula titrated to maintain an arterial oxygen saturation equal to or greater than 95%.

4. Thrombolytic therapy Used to dissolve thrombi in he coronary

arteries and restore myocardial blood flow.

Nursing Interventions

Position the client into orthopneic position to promote comfort and sufficient oxygenation.Provide calm, quiet environment and explanations of interventions often reduce anxiety and assist in relief of chest pain.If needed, instruct client to take several deep breath to increase oxygenation.

NURSING CARE PLAN

Problem identified:

Nursing diagnosis:

CUES NURSING INTERVENION

RATIONALE

INDEPENDENT:

COLLABORATIVE:

Problem identified:

Nursing diagnosis:

CUES NURSING INTERVENION

RATIONALE

INDEPENDENT:

COLLABORATIVE:

Problem identified:

Nursing diagnosis:

CUES NURSING INTERVENION

RATIONALE

INDEPENDENT:

COLLABORATIVE:

Problem identified:

Nursing diagnosis:

CUES NURSING INTERVENION

RATIONALE

INDEPENDENT:

COLLABORATIVE:

Problem identified:

Nursing diagnosis:

CUES NURSING INTERVENION

RATIONALE

INDEPENDENT:

COLLABORATIVE: