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Background of The Case

Patient R.A. was admitted to the hospital on November 26, 2006 and diagnosed with Acute Coronary Syndrome (ACS) based on symptoms of chest pain, elevated cardiac enzymes, and ECG findings. ACS describes a range of conditions caused by reduced blood flow to the heart and includes unstable angina, NSTEMI, and STEMI (heart attack). The case study aims to increase understanding of ACS by examining the patient's condition, risk factors, signs and symptoms, causes, incidence and prognosis of ACS.

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monmon
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31 views

Background of The Case

Patient R.A. was admitted to the hospital on November 26, 2006 and diagnosed with Acute Coronary Syndrome (ACS) based on symptoms of chest pain, elevated cardiac enzymes, and ECG findings. ACS describes a range of conditions caused by reduced blood flow to the heart and includes unstable angina, NSTEMI, and STEMI (heart attack). The case study aims to increase understanding of ACS by examining the patient's condition, risk factors, signs and symptoms, causes, incidence and prognosis of ACS.

Uploaded by

monmon
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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BACKGROUND OF THE CASE

• Patient R.A. was admitted to the


Cardiovascular Unit I of St. Luke’s Medical
Center on November 26, 2006.
• A diagnosis of Acute Coronary Syndrome was
made based on symptoms of chest pain,
elevated cardiac enzymes, and ECG findings.
• The patient received subsequent medical and
surgical management for this condition.
Reasons for choosing the case…

• At present, a large number of people observe unhealthy


practices or behaviors that contribute to the development of
ACS and other cardiovascular disorders.
• people may achieve a deeper understanding of the disorder
• a greater awareness of various exogenous and endogenous
factors which heighten the risk of developing ACS.
• prevention of the disease
• subsequent reduction in mortality and morbidity rates
resulting from ACS.
DEFINITION OF THE CASE
Acute Coronary Syndrome
• any group of clinical symptoms compatible with acute myocardial ischemia
• The initial diagnosis is based entirely on history, risk factors, and, to a
lesser extent, ECG findings.
• a set of signs and symptoms suggestive of sudden cardiac ischemia,
usually caused by disruption of atherosclerotic plaque in an epicardial
coronary artery.
• includes the symptoms of Unstable Angina (UA), Non-ST Segment
Elevation Myocardial Infarction (NSTEMI), and ST Segment Elevation
Myocardial Infarction (STEMI), commonly referred to as a heart attack.
• Primary prevention of atherosclerosis is controlling the risk factors:
healthy eating, exercise, treatment for hypertension and diabetes,
avoiding smoking and controlling cholesterol levels.
GENERAL SIGNS AND SYMPTOMS

Pain:
unstable angina

Cardiovascular Symptoms:
Palpitation, Jugular vein distention, S3 and S4,
Murmurs

Respiratory Symptoms:
Exertional dyspnea, Rales upon ausculatation
Gastrointestinal Symptoms:
Nausea

Musculoskeletal Symptoms:
Exercise intolerance

Integumentary System Symptoms:


Diaphoresis, cool clammy skin

Other (Emotional Symptoms):


Anxiety or a sense of impending doom
ETIOLOGY

Causes of ACS may be grouped into conditions


which:

A. Decrease Oxygen Supply


B. Increase Oxygen Demand
Decreased Oxygen Supply
• Atherosclerotic plaque
• Coronary artery vasospasm
• Embolic occlusion of the coronary arteries
• Hypoxia, as in carbon monoxide poisoning or acute
pulmonary disorders
• Cocaine and amphetamines
• Underlying coronary artery disease, which may be
unmasked by severe anemia
• Inflammation of epicardial arteries
• Coronary artery dissection
Increased Oxygen Demand

• Ventricular hypertrophy due to


hypertension
• valvular disease
• cardiomyopathy.
Risk factors for ACS
• Male gender
• Diabetes mellitus (DM)
• Smoking history
• Hypertension
• Increased age.
• Hypercholesterolemia and Hyperlipidemia
• Prior cerebrovascular accident (CVA)
• Inherited metabolic disorders
• Methamphetamine use
• Occupational stress
• Connective tissue disease
INCIDENCE
Frequency:

• In the US: Hospital discharge data indicate that 1,680,000 unique


discharges for ACS occurred in 2001.
• Internationally:
 In Britain, annual incidence of angina is estimated at 1.1 cases per
1000 males and 0.5 cases per 1000 females aged 31-70 years.
 In Sweden, chest pain of ischemic origin is thought to affect 5% of all
males aged 50-57 years.
 In industrialized countries, annual incidence of unstable angina is
approximately 6 cases per 10,000 people.
Mortality/Morbidity:

• Before improved treatment for angina :


 40% incidence of MI and a 17% mortality rate within 3
months.
• After improved treatment for angina :
 A 47% relative decrease in 30-day mortality among newly
diagnosed ACS from 1987-2000. Clinical characteristics
associated with a poor prognosis include advanced age,
male sex, prior MI, diabetes, hypertension, and multiple-
vessel or left-mainstem disease.
• Sex: Incidence is higher in males among all
patients younger than 70 years.

• Age: In persons aged 40-70 years, ACS is


diagnosed more often in men than in women.
In persons older than 70 years, men and
women are affected equally

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