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Acute Coronary Syndrome by Jo Anne Naylor RN, BSN CCU Educator

What is Acute Coronary Syndrome (ACS) ?. Acute Coronary Syndrome is when occlusion of one or more of the coronary arteries occurs, usually following plaque rupture, resulting in decreased oxygen supply to the heart muscle. ACS is the largest cause of death in U.S. Over 1 million people will have M

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Acute Coronary Syndrome by Jo Anne Naylor RN, BSN CCU Educator

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    1. Acute Coronary Syndrome by Jo Anne Naylor RN, BSN CCU Educator What is Acute Coronary Syndrome ? How can I look at an EKG and tell what part of the heart is affected ? What do ICU RNs need to know ?

    2. What is Acute Coronary Syndrome (ACS) ? Acute Coronary Syndrome is when occlusion of one or more of the coronary arteries occurs, usually following plaque rupture, resulting in decreased oxygen supply to the heart muscle. ACS is the largest cause of death in U.S. Over 1 million people will have Myocardial Infarctions this year; almost half will be fatal. Majority of mortality associated with ST Elevation Myocardial Infarction (STEMI).

    3. Who is at risk for ACS? Anyone with history of CAD, HTN, ESRD, DM Blood loss due to GI Bleed, surgery, trauma Patients on dialysis with AV Fistulas (? myocardial O2 demands) Decreased O2 saturations (particularly in COPD) Fever, hyperthyroidism, sustained tachycardia, prolonged hypotension, hypothermia, DIC, drug use (especially cocaine)

    4. Who is at risk for ACS? Conditions that may mimic ACS include: Musculoskeletal chest pain Pericarditis (can have acute ST changes) Aortic dissection Central Nervous System Disease (may mimic MI by causing diffuse ST-T wave changes) Pancreatitis/Cholecystitis

    5. The Three Is Ischemia= ST depression or T-wave inversion Represents lack of oxygen to myocardial tissue ST depression is where the ST segment drops below the baseline of the QRS segment; T wave inversion is where the T wave (following the QRS) is opposite the R wave (most often see flipped Ts)ST depression is where the ST segment drops below the baseline of the QRS segment; T wave inversion is where the T wave (following the QRS) is opposite the R wave (most often see flipped Ts)

    6. The Three Is Injury = ST elevation -- represents prolonged ischemia; significant when > 1 mm above the baseline of the segment in two or more leads

    7. The Three Is Infarct = Q wave represented by first negative deflection after P wave; must be pathological to indicate MI Some patients can have normal Q waves; in order for it to be considered pathologic, or indicative of transmural MI, the Q wave must be > 0.04 sec wide and 1/3 or > the height of the R waveSome patients can have normal Q waves; in order for it to be considered pathologic, or indicative of transmural MI, the Q wave must be > 0.04 sec wide and 1/3 or > the height of the R wave

    8. What part of the heart is affected ?

    9. Inferior Wall MI

    10. Based on the EKG, which vessel in the heart is blocked? II, III & aVF = Inferior Wall MI = Right Coronary Artery blockage

    11. Which part of the heart is affected ?

    12. Anterior Wall MI

    13. Based on the EKG, which vessel in the heart is blocked? V1 - V4 = Anterior Wall (Left Ventricle) = Left Anterior Descending Artery Blockage

    14. What part of the heart is affected ?

    15. Lateral Wall MI

    16. Based on the EKG, which vessel in the heart is blocked? I, aVL, V5 + V6 = Lateral Wall = Circumflex Artery Blockage

    17. What do ICU RNs need to know? You should do a 12-Lead EKG when: A patient who has CAD risk factors complains of Chest Pain When you are analyzing your rhythm strip on the flowsheet, and you notice that it looks different from the previous shift; OR any arrhythmias or changes in rhythm If your patient who is intubated / sedated suddenly begins to have hemodynamic changes putting stress on the heart + lungs Basically, anytime you notice EKG segment or rhythm changes, a 12-Lead EKG should be obtained and the doctor notified. If it turns out not to be heart-related, at least it will be documented. (Did you know this is one of the main reasons why we analyze and document rhythms? ?) Basically, anytime you notice EKG segment or rhythm changes, a 12-Lead EKG should be obtained and the doctor notified. If it turns out not to be heart-related, at least it will be documented. (Did you know this is one of the main reasons why we analyze and document rhythms? ?)

    18. What do ICU RNs need to know? Unexplained tachycardia Tachypnea Sudden elevation in PA catheter #s or ICP (unexplained) Nausea and/or diaphoresis that doesnt make sense Pallor Symptoms of sudden heart failure (pulmonary edema/crackles) Unexplained restlessness/all of a sudden needs more sedation

    19. Summary After completing an EKG, look at each of the leads for ST segment changes Remember the three Is: Ischemia, Injury, and Infarct !! Identify the section of the heart (and vessel supplying it) affected by the blockage according to the groups of leads changing in the EKG Remember the symptoms that would prompt you to obtain an EKG!

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