University of the East

RAMON MAGSAYSAY MEMORIAL MEDICAL CENTER. INC.

64 Aurora Blvd., Brgy Dona Imelda, Quezon City

ACUTE CORONARY SYNDROME

Submitted by: Bacanto, Nathaniel Ivan P.

N4A
INTRODUCTION

Acute coronary syndrome is a general term for any situation where the blood
supply to any part of your heart is suddenly reduced or blocked. It is an urgent situation
that requires immediate treatment. Once a diagnosis is made, you will receive
immediate treatment which may include procedures such as cardiac catheterization,
angioplasty, or even cardiac surgery. Once your condition is stabilized, further
treatments include medications, lifestyle modifications, and follow-up care.

Non-ST elevation myocardial infarction (NSTEMI), unstable angina, and ST-

elevation myocardial infarction (STEMI) are the three types of ACS. The terms STEMI,
NSTEMI, and unstable angina (UA) are most correctly used in patients who present with
clinical characteristics compatible with myocardial ischemia

The most common cause of ACS is coronary artery disease or narrowing of the
coronary arteries. These are the vessels which feed blood to the heart muscle. This
narrowing is usually caused by the buildup of cholesterol plaque in artery walls, leading
to atherosclerosis or hardening of the arteries. In some cases, ACS can happen when
plaque in the artery cracks open suddenly. A blood clot forms over the cracked plaque
and creates a narrowing inside the artery which partially or completely blocks blood
flow. The sudden reduction of blood supply to the heart muscle cells causes them to
die.

Atherosclerosis is characterized by a focal deposit of cholesterol and lipids,

primarily within the intimal wall of the artery. The genesis of plaque formation is the
result of complex interaction between the components of the blood and the elements
forming the vascular wall.

Conditions that fall under the ACS;

Unstable Angina

This occurs when plaque in the artery cracks open suddenly. A blood clot forms
over the cracked plaque and creates a sudden narrowing inside the artery. When this
happens, chest pain or angina may occur more frequently, with less exercise, or last
longer than usual. This change in the pattern of angina is called unstable angina and
puts you at increased risk for heart attack.

Myocardial Infarction

If the heart is starving for blood and not getting enough oxygen for more than 20
minutes, then a part of the heart muscle dies causing some permanent damage.
 Acute Coronary Syndrome is a major cause of mortality and morbidity in the
Asia-Pacific region and account for around half of the global burden from these
conditions, i.e. around seven million deaths and 129 million disability-adjusted life years
(DALYs) annually from 1990 to 2010.1–5 Significantly, during this period associated
mortality and morbidity accounted for nearly two-thirds of all DALYs and over half of
deaths from acute coronary syndromes occurring in low- and middle-income countries.
(WHO)

In the Philippines, statistics from the Department of Health (DOH) in 2005 show
that cardiovascular diseases ranked among the top ten leading causes of morbidity and
diseases of the heart and the vascular system are the top two causes of mortality in the
country.

Patient M.J. is a 80 y/o Female living with her family at San Carlos City, Pangasinan, she
was admitted to the Emergency Room because of a chief complaint of DOB of (2hrs) duration.
Present Health History

Patient M.J. is a 80y/o Female, Filipino, Roman Catholic, widowed wife living with her
family at San Carlos City, Pangasinan, she was admitted to the E.R. on 11/17/19 at 11:34pm
because of a chief complaint of Shortness of Breath (2hrs) duration.

2hrs PTA, patient complained of sudden epigastric pain described as sharp 8/10, which
radiated to the back associated with orthopnea, diaphoresis and chest heaviness. Patient took
Isordril upon noting that BP was 150/100,it provided minimal relief.

1hr PTA, patient’s symptoms persisted now with associated episode of vomiting of
previously ingested food of about (3tbsp) non bloody, mucoid and non-projectile BP was noted
to be 180/110 promting consult

In the ER, patient was given Maalox (20mL) Metropolol 50mg, 1/2 tab. Patient was
advised for admission and underwent ECG, Urinalysis, CBC, Creatinine, BUN, Na, K, Mg,
SGOT, SGPT, Amylase and Lypase.

Past Health History

Patient M.J. was born on February 23, 1939 in Dipaculao, Aurora, she was a High School
Graduate who worked as a Nursing Aide, and she lives with his children in a household of 4,
where her source of income is from Pension. Patient has a history of smoking (28 py, quit 2006),
has previous alcoholic beverage and denies illicit drug use.

Patient has a history of Type 2 DM, (+) HTN, COPD, Kidney Injury (2019), patient has
had surgeries in Laryngectomy (1970’s), Hysterectomy (TAHBSO) and Cyst Removal (1970’s).
 Concept Map

Acute Coronary Syndrome

Modifiable RF: Non- Modifiable RF:

- Lifestyle - Age (80 y/o)
- Diet - DM Type 2
- High Blood Pressure - Past Health History
(180/.110) (Cigarette Smoking)
- Family History

R/O: Pancreatitis
Plaque Formation

Amylase and
Lipase: Normal Atherosclerotic plaque
ruptures or explodes

Rule In: Nstemi

Thrombin is
generated and Fibrin Meds: Enoxaparin
High Sensitive is deposited
Troponin I:
10ng/L Platelet Aggregation Meds: Clopidogrel

Nausea and Vomiting Clot Formation

Thickening and
Narrowing of Arterial
Vessels

Cells become
Ischemic

Meds: Metropolol Decreased Lactic Acid secretion Decreased 02 supply

Amlodipine Myocardial Cell to Myocardium
Losartan contraction
Stimulates pain
BP: Decreased Cardiac receptor
Output
180/110
Meds: Aspirin S/Sx: Chest Pain
Decreased O2 supply
S/Sx: Epigastric Pain in different parts of
the body Chest Heaviness

8/10
Diaphoresis
Orthopnea
 REFERENCES

https://www.uptodate.com/contents/acute-coronary-syndrome-terminology-and-
classification

https://www.researchgate.net/publication/287292916_The_UP-
Philippine_general_hospital_acute_coronary_events_at_the_emergency_room_registry_UP
_PGH-ACER

https://www.ottawaheart.ca/heart-condition/acute-coronary-syndrome

https://www.who.int/bulletin/volumes/94/3/15-158303/en/

Borromeo, A.R., Lewis, S.L, Dirksen, S.R., Heitkemper, M.M., Bucher, L., Camera,
I.M., (2014) Lewis’ Medical Surgical Nursing Assessment and Management of Clinical
Problems Phil. ED.