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:red_flag:Acute Coronary Syndrome :red_flag: (:star:Myocardial Infarction…

- - - - -The American Heart Association estimates that 1.1 million Americans have an MI each year.
        -1/4 of those patients die in an emergency department or before reaching the hospital.
        -Leading cause of death from all cardiovascular disease
    - - Increased blood levels of low-density lipoprotein (LDL) irritate or damage the inner layer of coronary vessels.
        
        LDL enters the vessel after damaging the protective barrier, accumulates, and forms a fatty streak.
        
        Smooth muscle cells move to the inner layer to engulf the fatty substance, produce fibrous tissue, and stimulate calcium deposition.
        
        The cycle continues, resulting in transformation of the fatty streak into fibrous plaque and, eventually, a coronary artery disease (CAD) lesion evolves.
        
        Oxygen deprivation forces the myocardium to shift from aerobic to anaerobic metabolism, leading to accumulation of lactic acid and reduction of cellular pH.
        
        The combination of hypoxia, reduced energy availability, and acidosis rapidly impairs left ventricular function.
        
        The strength of contractions in the affected myocardial region is reduced as the fibers shorten inadequately, resulting in less force and velocity.
        
        Wall motion is abnormal in the ischemic area, resulting in less blood being ejected from the heart with each contraction.
        
        Plaques can rupture due to disruption of the fibrous cap, leading to acute events.
    - - Causes :star: Atherosclerosis:star:
        Non-modifiable risk factors for atherosclerosis
        :star: Age
        :star: Sex
        :star: Family history of premature coronary heart disease
        :star:L Male-pattern baldness
        Modifiable risk factors for atherosclerosis:
        :star: Smoking or other tobacco use
        :star: Hypercholesterolemia and hypertriglyceridemia
        :star: Dyslipidemia
        :star: Diabetes mellitus
        :star: Hypertension
        :star: Obesity (abdominal obesity)
        :star:Psychosocial stress
        :star: Sedentary lifestyle and/or lack of exercise
        :star: Reduced consumption of fruits and vegetables
        :star: Poor oral hygiene
        :star: Type A personality
        :star: Elevated homocysteine levels
        :star: Presence of peripheral vascular disease
    - - health history, assessment, 12-lead ECG, serum cardiac markers, angiography, echocardiogram, chest x-ray
    - - Heart failure, CAD, chest pain/angina, valve disease (aortic stenosis) cardiomyopathy, hypertension, diabetes, anemia, lung disease and hyperlipidemia
    - - Assess for Pain OPQRST
        Oxygen as prescribed
        Vital Signs with Continuous cardiac Monitoring
        Pain Management (Nitroglycerin, Morphine)
        Position of comfort (semi-Fowler's position)
        12-Lead ECG
        IV access
        Monitor Lab Values
        Thrombolytic Therapy as prescribed
        Assess for signs of poor cardiac output (pulses, skin temperature.)
        Monitor Blood Pressure due to administration of medications
        Bed Rest
    - - hypertension, tabacco use, incativity, obesity, diabetes, cholesterol (above 240)
    - - antiplatelet agents, glycoprotein inhibitors, anticoagulant agents, nitrates, ACE inhibitors, angiotensin II receptor blockers, B-adrenergic blockers, calcium channel blockers, opioid analgesics and thrombolytic agents.
    - - Past Health History: Previous CAD, chest pain/angina, M.I.
        Medications: Antiplatelets or anticoagulants, nitrates, ACE inhibitors, B-blockers (vitamin and herbs), etc Health perception:Family history of heart disease; sedentary lifestyle, tobacco use
        Nutritional-metabolic: Indigestion, heartburn, nausea, belching
        Elimination: Urinary frequency or urgency, straining at stool
        Activity-exercise: Palpations, dyspnea, dizziness, weakness
        Cognitive- Perceptual: Substernal chest pain of pressure, possible radiation to the jaw, neck, shoulders, etc
        Coping-stress: Stressful lifestyle, depression, anger, feeling of impending doom
        Objectively General: anxious, fearful
        Integumentary: Cool, clammy, pale skin
        Cardiovascular: Tachycardia or bradycardia, pulses alternant (weak or strong heartbeats) Dysrhytmias S3, S4
- - - - -Women seek medical attention for symptoms of UA more often than men
        -Women often present with UA before CAD is diagnosed.
    - - Risk factors (70 % blocks artery with plaque, cardiomyopathy, aortic stenosis etc.)
        
        Stress or exercise increases heart rate
        
        Small blood flow through artery due to narrowing of vessel
        
        Workload increases
        
        Oxygen demand increase
        
        Supply and demand exceeds
        
        Switch from aerobic to anaerobic metabolism
        
        Increase of glycolysis, and pyruvate formation
        
        Pain (Resolves with rest or cessation of activity= stable angina ((unstable angina no relief with pain therefore increase suspicion of worst injury. May be lethal))
    - - Causes:
        :star: Decrease in myocardial blood supply due to increased coronary resistance in large and small coronary arteries
        :star: Increased extravascular forces, such as severe LV hypertrophy caused by hypertension, aortic stenosis, or hypertrophic cardiomyopathy, or increased LV diastolic pressures
        :star: Reduction in the oxygen-carrying capacity of blood, such as elevated carboxyhemoglobin or severe anemia (hemoglobin, <8 g/dL)
        :star: Congenital anomalies of the origin and/or course of the major epicardial coronary arteries
        :star: Risk factors
        :star: Precipitating factors
        :star: Preventive factors
    - - assessment of factors prior to symptoms,
    - - Atherosclerosis, M.I.
    - - Assess for Pain OPQRST
        Oxygen as prescribed
        Vital Signs with Continuous cardiac Monitoring
        Pain Management (Nitroglycerin, Morphine)
        Position of comfort (semi-Fowler's position)
        12-Lead ECG
        IV access
        Bed Rest
    - - CAD, fatigue
    - - antiplatelet agents, glycoprotein inhibitors, anticoagulant agents, nitrates, ACE inhibitors, angiotensin II receptor blockers, B-adrenergic blockers, calcium channel blockers, opioid analgesics and thrombolytic agents.
    - - PQRST Assessment -P Precipitating events (What events or activities precipitated the painarguing, resting
        -Q Quality What does the pain feel like pressure, dull, aching, etc
        -R Radiation Where is the pain located and if it radiates to other areas back to neck, jaw shoulder, etc -S Severity On a scale from 1-10 10 being the worst pain -T Timing When did the pain begin? Has it changed since this time? Have you felt this pain before