Acute Coronary Syndrome Treatment Essay

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Acute Coronary Syndrome Treatment Essay

Risk%Stratification%Among”the”patients”with”NSTEMI,”10%”have”a”left”main”coronary”stenosis,”35%”have”a”three” vessel” CAD,” 20%” have” a” two” vessel” disease.” There” are” no” apparent” critical”epicardial” coronary” artery” stenosis.” The” culprit” lesion” is” responsible” for” the” ischemia”shows” an” eccentric” stenosis”with” scalloped” or” overhanging” edges” and” narrow” neck” on”coronary” angiography.” NSTEMI” frequently” have” multiple” plaques” that” are” at” risk” of”disruption”(vulnerable”plaques).”Patient”with”STEMI”have”a”wide”spectrum”of”early”risk”of” death” within” 30″ days.” NSTEMI” is” classified” by” the” severity,” clinical” history,” ECG”pattern,”serum”biomarkers.”They”are”classified”as”class”I”(new”onset”severe”angina),”class”II”(angina”at”rest”within”the”past”month”but”not”within”the”last”48″hours),”class”III” Acute Coronary Syndrome Treatment Essay (angina”at”rest”within”48″hours).”6,7″”Conclusion%%Acute” coronary” syndrome” is” one” of” the” most” common” cardiovascular” health” problem”and” many” are” affected” by” it” each” year.” Acute” coronary” syndrome” can” be” classified” to”unstable” angina,” non” St” segment” myocardial” infarction” or” NSTEMI,” and” STEMI.” The”common” symptoms” of” acute” coronary” syndrome” is” pain” that” radiates” from” the”substernal”to”the”jaws”and”the”left”arm.”Each”of”the”acute”coronary”syndrome”category”has” its” own” characteristics” that” can” be” used” to” identify” the” patients’” diagnosis.” This”patient”has”an”elevated”ST”segment”on”his”ECG,”and”he”has”most”of”the”risk”factors”as”well.” The”patient” also” has” the” symptoms” of” STEMI.”Therefore,” I” can” conclude” that” the”patient”suffers”from”STEMI

angina,”it”is”highly”possible“for”the”patient”to”have”myocardial”necrosis”and”proceed”to”
acute”MI.”Acute Coronary Syndrome Treatment Essay
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Myocardial%Infraction%
Myocardial”infarction”is”referred“to”as”heart”attack,”and”is”the”death”of”cardiac”muscle”
due”to”prolonged”severe”ischemia.”Myocardial”infarction”occurs”in”any”age,”most”occur”
in”people”younger”than”the”age”of”65.”MI”frequency”strongly”correlates”with”the”age.”MI”
strongly” correlates” with” the” genetic” and” behavioral” predispositions” to” atherosclerosis.”
Black” and” whites” are” equally” affected.” Through” the” middle” age,” the” male” fender”
increases” the” relative” risk” of” MI.” Generally,” women” are” more” protected” against” MI”
during” their” reproductive” years.” However,” postmenopausal” estrogen” decline” is”
associated” with” coronary” artery” disease,” ischemic” heart” disease” and” is” the” most”
common” cause” of” death” in” older” women.” Unfortunately,” postmenopausal” hormonal”
replacement”therapy”has”not”been”shown”to”be”protective.Acute Coronary Syndrome Treatment Essay
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Coronary” arterial” occlusion” undergoes” this” following” mechanism.” The” coronary” artery”
atheromatous”plaque”undergoes”an”acute”change”consisting”of”intraplaque”hemorrhage,”
erosion,”ulceration”or”rupturing.”When”it”is”exposed”to”the”subendothelial”collagen”and”
necrotic”plaque”contents,”the”platelets”aggregate”to”form”a”microthrombi.””Vasospasm”
will”be”stimulated”by”the”mediators”released”from”the”platelets.”Tissue”factors”activates”
the” coagulation” pathways” adding” to” the” bulk” of” the” thrombus.” Within” minuets,” the”
thrombus”can”expand”to”completely”occlude”the”vessel’s”lumen.”Approximately”10%”of”
MI” are” transmural” MI” that” occurs” in” the” absence” of” the” typical” coronary”
atherothrombosis.”In”this”situations,”these”following”mechanism”are”responsible”for”the”
reduced”coronary”blood”flow.”
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Vasospasm” with” or” without” coronary” atherodclerosis” are” associated” with” platelet”
aggregation” or” drug” ingestion.” Emboli” from” the” left” atrium” are” associated” with” atrial”
fibrillation,” a” left-sided” mural” thrombus” and” vegetation” of” infective” endocarditis,”
intracardiac” prosthetic” material.” Ischemia” without” detectable” of” significant” coronary”
atherosclerosis”and”thrombosis”may”be”caused”by”the”disorders”of”small”and”thrombosis”
may”be” caused” by” the” disorder” of” small” intramural”coronary” vessels.” Coronary”arterial”
obstruction” diminishes” the” blood” flow” to” a” region” of” myocardium” causing” ischemia,”
myocardial”dysfunction,”and”eventually”a”prolonged”vascular”compromise”and”myocyte”Acute Coronary Syndrome Treatment Essay
death.”The”anatomic”region”that”is”supplied”by”that”artery”is”referred”to”as”the”area”of”
risk.”The” out” come”depends” on” the”severity” and” the”duration” od”the” flow” deprivation.”
The” early” biochemical” consequences” of” myocardial” ischemia” is” the” cessation” od” the”
aerobic”metabolism”that”leads”to”inadequate”production”of”high”energy”phosphates”and”
accumulation”of”potentially”noxious”metabolites”(eg.”Lactic”acids).
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The”specific”morphological”features”of”an”acute”MI”depend“on”the”location,”the”size,”the”
duration”and”the”metabolic,”the”oxygen”needs”of”the”myocardium”at”risk,”extent”od”the”
collateral”blood” vessels,” the” presence,” site,”and” severity”of” the” coronary” arterial” spas,,”
and” other” factors” such” as” the” heart” rate,” cardiac” rhythm” and” the” blood” oxygenation.”Acute Coronary Syndrome Treatment Essay

Acute coronary Syndrome(ACS) is the leading cause of mortality and inability in the western world.(emergency medicine Australia .(2011)) )According to Ministry of Health 40% of death in New Zealand is caused by cardiovascular disease(CVD) and 1 in 4 of this mortality is due to coronary artery disease. one new zealander dies every 90 minutes from CVD.classification of ACS. In ACS Non ST elevation MI(NSTEMI) patients exhibit a greater part in most of the registries, in addition NSTEMI patients have an increased rate of cardio vascular complications.(…….)This essay discusses the importance of the knowledge base development and clinical skills in the area of NSTEMI.Both in acute and community settings nurses play a vital role in the prognosis of patients with acute coronary syndrome.Nurses can contribute towards the diagnosis, prevention and effective management of ACS if they have better clinical understanding of the pathophysiology and classification of ACS.(LEARNING ZONE 04/02/2011 13:04 PAGE 47. it describes the rationale by discussing a case study with supporting literatures which links some specific strategies to improved health outcomes and includes a professional development Acute Coronary Syndrome Treatment Essay

NSTEMI comes under the definition of ACS.NSTEMI usually caused by rupture of an atherosclerotic plaque and erosion with thrombus formation within the coronary arteries leading to decreased myocardial blood supply resulting in myocardial ischeamia.The frequency of NSTEMI has increased over the years and the death associated with this continues to be higher or almost similar to STEMI. Thus it is clear that the management of these group is challenging to health care providers. (Cayla, Silvain, Collet, & Montalescot, 2015).Acute Coronary Syndrome Treatment Essay

Assignment finished below following case information

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.

ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.Acute Coronary Syndrome Treatment Essay
BP: 100/50

Patient was started on tpA Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
Thrombolytic medications are approved for the immediate treatment of stroke and heart attack. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing. Acute Coronary Syndrome Treatment Essay