.

1. ACUTE CORONARY
SYNDROME
THANUJA ELEENA MATHEW

7. ETIOLOGY
• Build up of fatty deposits {plaques}
• Older age [older than 45 for men and >55 for women]
• High blood pressure
• High blood cholesterol
• Cigarette smoking
• Lack of physical activity
• Unhealthy diet
• Obesity or over weight
• Diabetes
• Family history of heart disease, chest pain or stroke.

10. DIAGNOSTIC EVALUATION
• History collection
• Physical examination
• ECG
• Blood test
• Echo cardiography
• Chest x-ray
• Angiography
• Ct scan

11. MYOCARDIAL INFRACTION
•Decreased coronary blood circulations and oxygen
circulations due to myocardial tissue necrosis due
to atherosclerosis or occlusion of coronary artery
circulation.

14. PATHOPHYSIOLOGY
• Due to etiological factors
• Deposition of lipids
• Inflammation
• Secrets T lymphocytes and B monocytes
• Infiltrate the area to ingest lipids and then die
• Smooth muscle proliferation
• Forms fibrous cap over the dead fatty core[atheroma]
• Protrude into the lumen of vessels.
• Obstruct the blood flow

15. Obstruct the blood flow
• Atheroma is thick
• Resist blood flow
• Atheroma is thin
• Lipid core grow and rupture
• Haemorrhage
• Thrombus
• Death of heart tissue[ necrosis, ischemia occurs]
• Therefore sudden cardiac death or acute MI.

16. MANAGEMENT
• Bed rest
• Oxygen administration
• Dietary management
Low cholesterol/ fat
Low sodium
More fibre
• Managing hypertension and DM

17. PHARMACOLOGIC THERAPY
• Thrombolytic therapy
• E.g.: streptokinase, urokinase, reteplace
• Analgesics e.g.: morphine sulphate
• ACE inhibitors e.g.: captopril, anapril
• Vasodilator e.g.: nitro-glycerine.
• B Blockers e.g. atenolol, propranolol
• Ca Channel blocker e.g. nifedipine
• Anticoagulants and antiplatelets e.g. aspirin, heparin, warfarin.

18. SURGICAL MANAGEMENT
• PTCA
• PTCA with atherectomy
• PTCA with intra vascular stent
• Lasers
• CABG

19. NURSING MANAGEMENT
• Bed rest in a semi fowlers position
• Oxygen administration
• Observe signs of respiratory distress
• Monitor ECG and vital signs
• Music therapy
• Medication
• Monitor ABG and heart sound
• Monitor intake and output chart
• Avoid risk factors.

20. NURSING DIAGNOSIS
• Acute pain related to tissue ischemia as evidenced by reports of chest pain
• Fear and anxiety related to threat or change in health status as evidenced by
fearful attitude.
• Deficient knowledge related to lack of information as evidenced by questions.
• Risk for decreased cardiac output related to changes in rate and rhythm
• Risk for ineffective tissue perfusion related to vasoconstriction.