Page 51 - Critical Care Notes

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Acute Coronary Syndrome (ACS)
ACS is the term used to denote any one of three clinical manifestations of coro-
nary artery disease:
■ Unstable angina
■ Non–ST-elevation MI (NSTEMI)
■ ST-elevation MI (STEMI)
Pathophysiology
Unstable angina represents the progression of stable coronary artery disease
to unstable disease. Rupture of atherosclerotic plaque causes thrombus forma-
tion and partial occlusion in coronary arteries that precipitate a myocardial
infarction.
Clinical Presentation
ACS manifests with chest pain, diaphoresis, SOB, nausea and vomiting, dysp-
nea, weakness, and fatigue. Symptoms of MI are midsternal chest pain
described as pressure, squeezing, fullness, or pain. May radiate to jaw, neck,
arms, or back and usually lasts more than 15 min.
Assessment for chest pain and associated symptoms of ACS include use of
PQRST method when assessing pain, physical exam, vital signs, auscultation
for S 3 or S 4 gallop, auscultation of lungs for crackles, and assessment of periph-
eral vessels for pulse deficits or bruits.
Diagnostic Tests
■ ECG
■ Echocardiogram
■ Cycle cardiac markers (troponin I, CK, CK-MB, myoglobin, C-reactive
protein)
■ Chest x-ray
■ Nuclear scan
■ CT angiography
■ Coronary angiogram
■ Fibrinogen level
■ Homocystine lipoprotein levels
■ Total cholesterol and triglyceride levels
■ Brain natriuretic peptide (BNP)
■ PT/PTT
CV