Acute coronary syndrome

Acute coronary syndrome

  • Etiology and pathophysiology
    • Process
      • Deterioration of once stable plague
      • Rapture
      • Platelet aggregation
      • Thrombus
    • Result
      • Partial occlusion of coronary artery: UA or NSTEMI
      • Total occlusion of coronary artery: STEMI
  • Clinical manifestation of ACS
    • Unstable Angina
      • New in onset
      • Occurs at rest
      • Increase in frequency, duration, or with less effort
      • Pain lasting > 10 minutes
      • Needs immediate treatment
      • Symptoms in women often under-recognized
    • Myocardial infarction (MI)
      • ST-elevation and non-ST-elevation
      • Result of abrupt stoppage of blood flow through a coronary artery, causing irreversible myocardial cell death (necrosis)
        • Pre-existing CAD
        • STEMI – occlusive thrombus
        • NSTEMI – non-occlusive thrombus
      • Pain
        • Severe chest pain not relieved by rest, position change, or nitrate administration
          • Heaviness, pressure, tightness, burning, constriction, crushing
          • Substernal or epigastric
          • May radiate to neck, lower jaw, arms, back
        • Often occurs in early morning
        • Atypical in women, elderly
        • No pain if cardiac neuropathy (diabetes)
      • Catecholamine release and stimulation of SNS
        • Release of glycogen
        • Diaphoresis
        • Increased HR and BP
        • Vasoconstriction of peripheral blood vessels
        • Skin: ashen, clammy, and/or cool to touch
      • Cardiovascular
        • Initially, increase HR and BP, then decrease BP (secondary to decrease in CO)
        • Crackles
        • Jugular venous distention
        • Abnormal heart sounds
          • S3 or S4
          • New murmur
      • Nausea and vomiting
        • Reflex stimulation of the vomiting center by severe pain
        • Vasovagal reflex
      • Fever
        • Up to 100.4° F (38° C) in first 24-48 hours
        • Systemic inflammatory process caused by heart cell death