Symptoms And Treatment Of Acute Coronary Syndrome

|Required: |Heart |The heart and circulatory system | Coronary artery disease (narrowing of the |

Nevertheless, there is an understandable and noticeable link between circulatory related diseases and lifestyle diseases, such as Coronary Heart Disease. Coronary heart disease can occur when fatty acids, such as cholesterol in an inadequate diet, build up in the walls of the coronary artery. These fatty deposits collect minerals and harden to become a plaque. Eventually, this plaque grows and can swells up, forming an aneurism. In some cases, this aneurism may burst leading to instant death. As it continues to grow and swell up, it finally blocks the artery completely and forms blood clots. This is known as coronary thrombosis. A myocardial infarction, or in other words as heart attack, occurs when no oxygen is able to reach the coronary artery and thus it is unable to fulfil its role in providing the heart muscle with a sufficient supply of blood. Heart attacks are very common in the society nowadays, especially occurring in smokers or obesity related diseases (Millar, June 2014)

Coronary artery disease (CAD) is the commonest heart disease in the United States1. Approximately, 29% of patients with Myocardial Infarction ( MI ) present with ST- elevation Myocardial Infarction ( STEMI )2. STEMI is the result of complete occlusion of a major epicardial coronary artery due to thrombus formation. STEMI from a small coronary artery presenting as substantial EKG abnormalities similar to occlusion of a major artery and hemodynamic instability is a rare entity. The epidemiology, typical clinical presentation, outcomes, and optimal management in this group of patients are not sufficiently known.

Condition where the left side of the heart is unable to pump an adequate amount of blood to the body, and can be life-threatening.

For this myocardial infarction, the right coronary artery was blocked. The parts of the heart that were affected by this blockage was the right atrium, the right ventricle, the interventricular septum, the Sinoatrial node and the AV node, and some parts of the left atrium and ventricle. These parts were affected because the right coronary artery supplies blood to these parts of the heart; since there was a blockage the blood was not able to continue through the right coronary arteries into its branches, which are the sinoatrial nodal artery, the right marginal branch, the posterior interventricular branch, and the atrioventricular nodal artery (Gest).

The pathophysiology of ACS includes the stable plaque forms get converted into unstable plaque forms.2 These unstable plaque forms have numerous thin fibrous cap cells, inflammatory cells, activated macrophages, and smooth muscle cells. Sympathetic activity increases myocardial contractility, pulse rate, blood pressure, and coronary blood flow which leads to plaque rupture or fissure. As the artery ruptures, it causes thrombus formation and ischemia in this particular artery. Depending on the condition, different thrombi could form. The unstable angina forms a small thrombus formation, NSTEMI forms a partial thrombus formation, and STEMI forms a complete and persistent thrombus. The risk factors involved in ACS are age, physical inactivity, and history of hypertension, diabetes, or angina. The signs of acute coronary syndromes are an acute heart failure, tachycardia, bradycardia, or heart blockage, and the symptoms of ACS consist of chest pain, pain in the extremities, nausea, shortness of breath, heavy

ACS also referred to as Acute Coronary syndrome is the blockage of blood flow to the heart. Some symptoms that occur when ACS takes place is chest pains (angina pectoris), having pains in the upper and lower extremities, shortness of breath, nausea and sweating. There are risk factors that can increase your risk for ACS such as smoking, high blood pressure, high cholesterol and diabetes. Some ways in order to test for ACS is a blood test and electrocardiogram. It can show whether or not heart cells are dying. After being diagnosed with ACS, treatment is available. Some treatment options include medications, angioplasty and stents.

In the management of an NSTE-ACS patient who underwent early PCI, is there any distinction between Plavix and Brilinta in reducing thrombotic CV events?

treatment for ACS is the patient’s decision to delay seeking care,” (De Vonn et al., 2011).

An interesting case I attended to involved an elderly man in his 80s who is a non-smoker and non-alcoholic. He looked grayish, pale and sweaty, which is the typical appearance of a cardiac patient. He presented with chest pain that he gave a pain score of 8/10, and which worsened upon inspiration. He also presented with vomiting and shortness of breath. Electrocardiogram (ECG) indicated a ST Elevation Myocardial Infarction (STEMI). Paramedic believes it was an anterior infarct with elevation in V2, V3, V4 leads and reciprocal depression in Leads II, III and aVF. The patient had several risk factors for heart disease such as high blood pressure, being overweight and living a sedentary lifestyle. He has had chest pain previously, but it was

It is mainly as a result of one of these three problems: ST elevation myocardial infarction, unstable angina and lastly non ST elevation myocardial infarction with chest pain being the main symptom (Linton, 2012). There are five main pathophysiologic processes that contribute to the development of ACS: thrombus on pre-existing plaque, active obstruction from coronary spasm, progressive mechanical obstruction, infection and unstable angina due to oxygen supply to myocardial (Linton, 2012). ACS is mainly caused by thrombus formation on a pre-existing plaque and it can be demonstrated through angiography or autopsies (Marshall, 2010). A thrombus is formed from plasma coagulation and platelets. There are risk factors that contribute to ACS such as cigarette smoking, diabetes, hypertension and high blood cholesterol (Linton, 2012). Both men and women are at a risk of having a heart attack. However it is more common in men especially when having a family background of heart attack, being overweight and inactive (Scruth, Carter, Cheng, Rolley, & Page, 2012). Modifying and identifying the risk factors is important as it can prevent further heart problems.

     Heart attack occurs when a blood clot suddenly and completely blocks a diseased coronary artery, resulting in the death of the heart muscle cells supplied by that artery. Coronary and Coronary Thrombosis 2 are terms that can refer to a heart attack. Another term, Acute Myocardial Infarction 2, means death of heart muscle due to an inadequate blood supply.

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

Angina is pain due to an increase in demand of oxygen during activity such as exercise. Angina can produce pain similar to that of a heart attack such as sternal pain between breast bones that radiates to left arm, left jaw pain and heaviness on a person’s chest. The pain can be described as burning, squeezing, tightness even aching (Parikh & Kadowitz, 2014). The symptoms of angina are a result of myocardial ischemia. This is a condition of insufficient blood flow from the coronary arteries to heart muscle (Heston, 2015).

Once at the hospital tests will be done to rule out other chest pain related causes. The first test that will be done is an Electrocardiogram or an EKG, which records the hearts electrical activity. Damaged heart cells are not able to produce electrical impulses which will produce abnormal EKG results. Elevations in the ST waves on an EKG are classified STEMI and are present in over ninety percent of myocardial infarctions who had a complete occlusion to an artery (Cardiac Emergencies, n.d.). NSTEMI is where there is no elevation of the ST wave and is indicative that a full occlusion has not occurred (Cardiac Emergencies, n.d.).