Acute coronary syndrome (ACS) is caused by decreased blood flow in the coronary arteries resulting in damage to heart muscle. It is categorized into ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina based on ECG and blood test results. Risk factors include smoking, hypertension, diabetes, and hyperlipidemia. Signs and symptoms include chest pain that may radiate to the arms. Diagnosis involves cardiac troponin and CK-MB blood tests and imaging like echocardiogram. Treatments include medications, thrombolysis, percutaneous coronary intervention (PCI), and coronary bypass surgery. Nursing management focuses on monitoring for complications, providing comfort measures, educ

1. P R E S E N T E D B Y ;
L T ; A Y E M Y A T H A N D A R
( 2 1 / 1 0 0 ) M H
ACUTE CORONARY SYNDROME

2. Acute Coronary Syndrome is
 Due to decreased blood
flow in the coronary
arteries so that part of
the heart muscle is
unable to function
properly or dies
 Clinical symptoms that
equate to myocardial
ischaemia

3. ACS is subdivided in three types depending on ECG
changes and blood test result,
1. ST elevation myocardial
infarction (STEMI)
2. Non-ST elevation myocardial
infarction (NSTEMI)
3. Unstable angina

5. Causes of ACS
. Result of plaque disruption in the coronary
arteries
. Common risk factors are
* Smoking
* Hypertension
* Diabetes
* Hyperlipidemia
* Family obesity, poor nutritional practices

6. Signs and Symptoms of ACS are:
 Midsternal or substernal compression or crushing chest
discomfort
 May be described as pressure, tightness or heaviness in the
chest
 Unexplained indigestion or epigastric pain
 Radiate to neck, jaw, shoulder, back and one or both arms

7. Investigations
 Cardiac Troponins T (Normal - less than 0.04 ng/ml)
 Cardiac Troponins I (Normal - between 0 and 0.04
ng/mL) , High-Sensitivity cardiac troponin (hs-cTn)
(Normal - < 14ng/L)
 CKMB (Normal 5 to 25 IU/L)
 Cath Profiles For Procedure
1. CP,ESR
2. U&C, Electrolyte, Lipid Profile, LFT, TFT
3. Serology
4. PT, INR

8. Non Invasive - Echo
Regional Wall Motion Septal Hypokinesia

9. Non Invasive – Exercise ECG (Treadmill)

10. Non Invasive – CT Ca++ Score

13. ST-Elevation Myocardial Infarction
Result from complete and prolonged occlusion of an
epicardial coronary blood vessel

14. ST-Elevation Myocardial Infarction

15. Non-STEMI
 Result from severe coronary artety narrowing,
transient occulsion
 Elevation of cardiac biomarkers in the absence of ST
elevation

16. Unstable Angina
 Heart doesn’t get enough blood flow and oxygen
 Occur at rest
 Become more frequent, severe and prolonged
 Not response to rest or nitroglycerine

17. Approach-to-diagnosis and risk stratification of
ACS

18. Approach-to-diagnosis and Management

19. Treatments
(1) Medications
(1) Antiplatelet
(2) Anti Ischaemic
(3) Anti Coagulant

20. Treatments
(2) Thrombolysis
IV infusion
Streptokinase 15 lks +
NS 100 ml within 1 hr
(100ml/hr)

21. Treatments
(3) Percutaneous coronary intervention ( PCI )

22. Treatments
(4) Coronary bypass surgery

23. Nursing Management

24. Assessment
 Changes in vital signs ( BP, PR,SaO2,HR)
 Shortness of breath or dyspnoea
 Tachycardia
 Dizzness, changes in level of consciousness
 Pallor
 Nausea and vomiting
 Anxiety
 Irritability
 Decrease peripheral pulse

25. Diagnosis
 Acute pain related to decrease blood and oxygen
supply to myocardium.
 Activity intolerance r/t cardiac dysfunction and
imbalance in oxygen supply.
 Anxiety r/t pain and perceived thread of death.
 Knowledge deficit r/t anxiety seondary to not
knowing the disease process.

26. Planning
 may be relieved from currently suffered chest pain.
 may be coped with the anxiety.
 may be understand the causes and treatment plans
of the disease.

27. Implementation
 Assess respirations, BP and heart rate with each
episodes of chest pain.
 Provide comfort measures such as back rub.
 Maintain bed rest during pain with position of
comfort.
 Prepare for the administration of prescribed
medications and monitor response to drug therapy.

28.  Caution patient to avoid activities that incerase
cardiac output.
 Observe skin colour, temperature and capillary refill
time.
 Monitor intake and output and calculate 24 hr fluid
balance.
 Administer oxygen as indicated.
 Decrease the patient’s anxiety by explaining the
disease, cauative factors DOs and DON’Ts, and
available treatments.
Implementation – Con;

29. Evaluation
The patient had
1. relieved from pain .
2. relieved from anxiety.
3. understood about the disease and Dos and
DON’Ts