Acute Coronary Syndrome

What do you do if a patient complains of chest pressure, left shoulder pain, and jaw pain?
Morphine
- Used for vasodilitation and pain control
Oxygen
- To increase oxygenation of parts of the heart that are not getting adequate oxygen
Nitroglycerin (NTG)
- Used for coronary artery dilation
- Many routes, but likely given sublingually or IV
Aspirin
- Antiplatelet agent used to prevent further clotting
- Does not bust the existing clot
TPA
- Consider using a clot buster to dissolve the clot
EKG
- ST depression (infarcting)
- ST elevation (infarcted) 
- T wave abnormalities
- Q wave abnormalities
- Dysrhythmias
Cardiac enzymes
- CK-MB
- Troponin
- Myoglobin
- May do serial enzymes (i.e. every 8 hours) to see trends of enzymes
Ask patient to describe pain: location, radiation qualities, improvement with sitting up or breathing?, intensity


Other Likely Treatment Options:
Metoprolol
- Beta blocker
- Used to prevent ventricular dysrhythmias that may cause death after an MI
- Usually given IV
Heparin
- Prevent further clotting
- Monitor PTT
- Reversal is protamine sulfate
Hyperlipidemic treatments (like -statins)
- Prevent further cholesterol build up


Lewis, Heitkemper, & Dirksen, 2004

Resources:
Women and Heart Disease Fact Sheets (including statistics and risk factors): http://www.cdc.gov/DHDSP/library/fs_women_heart.htm
Men and Heart Disease Fact Sheets: http://www.cdc.gov/DHDSP/library/fs_men_heart.htm
Atrial Fibrillation useful information (including s/s): http://www.cdc.gov/DHDSP/library/fs_atrial_fibrillation.htm
Heart Failure facts (easy to understand s/s, definitions, facts): http://www.cdc.gov/DHDSP/library/fs_heart_failure.htm