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    Diagnosis Course: Education Team

    Uploaded by

    mahmoudabdrabau

    Copyright:

    © All Rights Reserved
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    Diagnosis Course: Education Team

    Uploaded by

    mahmoudabdrabau
    7 views30 pages

    Original Title

    ACS

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    © All Rights Reserved
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    7 views30 pages

    Diagnosis Course: Education Team

    Uploaded by

    mahmoudabdrabau

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 30

    Diagnosis

    Course

    Education Team
     Definition of coronary artery disease.

     Anatomy of the coronary artery disease.

     Pathophysiology of atherosclerosis.

     Causes of coronary artery disease.

     How coronary artery disease is diagnosed.

     Nursing interventions for patients with CAD.


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     Medications used in coronary artery disease.
    Anatomy of coronary artery

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    title

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    What is Acute Coronary Syndrome?

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     Modifiable
     Smoking

     Obesity

     Diet

     Lack of exercise

     High serumcholesterol
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     Hypertension
     Non-Modifiable

     Increasing age

     Gender (male)

     Family History

     Diabetes
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     Chest pain

     Palpitations

     Dyspnea

     Hypotension or hypertension

     Asymptomatic/silent
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     Syncope
     Acute confusion

     Tachycardia or bradycardia

     Sweaty

     Vomiting

     Pallor

     Indigestion
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     Fever
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    SA: UA: NSTEMI STEMI
    plaque platelet Platelet Complete
    formation adhesion Aggregation Occlusion

     At rest or minimal exertion


     Precipitated by stress or exertion
     Lasts >20 minutes
     Lasts <20 minutes
     Often accompanied by other s/s 12
     Relieved by nitroglycerin or resting
     Poor nitroglycerin relief
    Bedside ECG
    Blood CBC, lipids, cardiac enzymes, amylase, CRP
    Imaging CXR
    Special Echo, angiography

    UA NSTEMI STEMI
     Normal troponin  Raised troponin  Raised troponin
     ECG normal  ST depression  ST elevation
     Possible ST  Can be normal  Hyperacute T waves
    depression  Possible T wave  New LBBB
    inversion  T wave inversion
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     *ST elevation is >1mm in limb leads and >2mm in chest leads


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    A Patent
    B Oxygen (aim for sats 94-98%), auscultate, RR
    C IV access (+/-fluids), HR, BP
    D GCS, pupils, cap blood glucose
    E Expose

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     Morphine (5-10mg slow IV injection)

     Oxygen

     Nitrates

     Aspirin (300mg chewed)

     Plus an antiemetic i.e. Metoclopramide 10mg IV 18


     Heparin1mg/kg BD or arixtra 2.5mg

     Aspocid 300 mg

     Plavix 300mg loading dose

     Beta blocker - atenolol 5mg

     Nitrates – usually IV

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     Consider coronary angiography within 72 hr
     TIME IS MUSCLE

     Percutaneous coronary intervention (Primary PCI)

     Call to balloon time’ of 120 minutes

     Requires Clopidogrel 600mg or ticagrelor 180mg loading dose

     Rescue PCI after failed thrombolysis


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     TIME IS MUSCLE

     Thrombolysis

     T-PA within 30 min if PCI not available

     Streptokinase, if Contraindicated:

     Plavix 600mg loading dose Clexane

     Beta blocker i.e. Atenolol, Inderal

     ACE inhibitor i.e. capoten


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     Door-to-needle shouldn’t exceed 30 min, Door-to-balloon shouldn’t exceed 90 min
    CABG: if multi-vessels are affected or PCI failed

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     There is a score that clinicians used to show the best choice for the patient

    (PCI,CABG).

     It is called JEOPARDY score that used since 1988.

     Today there is the syntax score for cath lab , STS and euro score for surgery.

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    STS SCORE

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     Continuous ECG monitoring as inpatient/ CCU

     Aspirin 75mg OD (lifelong)

     Plavix 75mg (1 year)

     Beta blocker (Inderal) for (1 year - lifelong)

     ACE inhibitor (Capoten)

     Statin (Ator, lipitor, Crestor)

     Some patients needs TAT (NOACs)


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     Modification of risk factors
    Early <72hr

     Death

     Cardiogenic shock

     Heart failure

     Ventricular arrhythmia

     Thromboembolism

     Ventricular wall Late rupture & Myocardial rupture

     Valvular regurgitation

     Ventricular aneurysms 27

     Cardiac tamponade
     Pain management.

     Semi-sitting position.

     Psychological support.

     Oxygen if indicated.

     Continuous monitoring of vital signs and ECG: arrhythmia or arrest may occur.

     Patient education about treatment and life style modification.


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     Preparing patient for catheterization or CABG if indicated.

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