Post on 24-Dec-2015
transcript
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 cocaine-associated 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 DiscomfortUnstable Symptoms
No ST-segment
elevation
Unstable Non-Q Q-Wave
angina AMI AMI
ST-segment
elevation
History
Physical Exam
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. Notify Rapid Response team by calling 8263.2. STAT EKG, CK Total, CKMB, Troponin1.3. Saline lock if no IV access.4. After EKG obtained, NTG 0.4 mg SL q5 minutes up to 3 tabs
prn for chest pain. Hold if systolic B/P <100.5. Nasal O2 at 2LPM, titrate to keep O2 saturation 90% or
greater.6. Notify physician of current assessment, vital signs and above
actions taken. Have patient chart, current medication list and labs available when calling physician.
7. Nurse should not delay calling the attending physician because of waiting on lab results.
Any
questions?questions?
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