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Acute Coronary Syndrome

Study Center > Student Study Guides > Acute Coronary Syndrome

Anatomy and Physiology Review

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Coronary arteries
Chambers of the heart
Perfusion

Pathophysiology: Acute Coronary Syndrome

  • Atherosclerosis: The buildup of plaque (cholesterol, collagen, etc.) in between the layers of the arteries.
  • Vessels narrow due to plaque buildup and subsequent decrease in blood flow
  • Plaque rupture occurs, leading to localized clotting (thrombus)
  • Vessel becomes occluded by thrombus, leading to disruption of oxygenated blood delivery to cells downstream (myocardial infarction)

Signs and Symptoms

  • Discomfort in chest, jaw, neck, shoulders, arms and upper abdomen
  • Shortness of breath (dyspnea)
  • Nausea/vomiting
  • Syncope
  • Diaphoresis
  • Cardiac arrest

Treatment: Acute Coronary Syndrome

  • Initiate transport/request ALS.
    • Consider appropriate destination hospital and make early notifications.
  • If indicated, administer oxygen to maintain saturations of 94%.
  • If permitted, obtain a 12-lead ECG.
  • If no contraindications, administer 324 mg aspirin by mouth.
  • If no contraindications, administer 0.4 mg sublingual nitroglycerin.
    • May repeat after 5 min if no contraindications.

Important Concepts: Acute Coronary Syndrome

  • Atypical is typical. Acute myocardial infarction has a wide range of presentations.  Have a high degree of suspicion with any patient who has any combination of symptoms, and beware atypical presentations.
  • Time is muscle. Intervention is time-sensitive. Delay means increased tissue damage and higher mortality rates.
  • If allowed by protocol, use 12-lead ECG to confirm the diagnosis. However, remember that ACS cannot be ruled out with the absence of ECG findings.
  • Consider cardiac arrest as a sign of ACS. Post-arrest patients should be treated for ACS  because it is the most common cause.

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