Pathophysiology and Pharmacology Applied to Nursing

Running head: ACUTE CORONARY SYNDROME 1
PATHOPHYSIOLOGY AND PHARMACOLOGY APPLIED TO NURSING
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ACUTE CORONARY SYNDROME 2
Introduction
The paper will respond to the given questions with reference to the case study of
Betsy Blogger who is 72 years with complains of shortness of breath and nauseas in the
surgical ward. She also has uncomplicated fixation of the right tubula and the fibula fracture
for a period of two period. The patient has a past medical history of Coronary Heart Disease,
Coronary Artery Bypass Graft (CAGs), Hypertension, Chronic Obstructive Pulmonary
Disease (COPD), and Type 2 Diabetes. The current medication regimens for the patient
include Aspirin, endone, diltiazem, paracetamol, enoxaparin, GTN spray, salbutamol,
pravastatin, metformin, and Spiriva 2 puffs. With reference to the case scenario of Betsy, the
paper will provide a rationale for the request of the ECG, describe the underlying
pathophysiology of angina with regard to the causes, outcomes, and progression and the risk
factors associated with the increased risk of the development of Acute Coronary Syndrome to
the patient.
Thirdly, the paper with analyze and interpret Betsy’s ECG which was taken while
experiencing shortness of breath and nausea. Fourthly, the paper will discuss three central
findings that may indicate Acute Coronary Syndrome and discuss the GTN, pravastatin, and
diltiazem medications including their groups, mechanisms of action, side effects and
complications, and the nursing considerations. Lastly, the paper will discuss the use of and
mechanism of action of ticagrelor and aspirin in a patient with cardiac problems, use of
morphine in the Acute Coronary Syndrome, and an elaboration of the linkage between high
risk of depression in patients with chronic illnesses such as Coronary Heart Disease.
Question 1: Interpretation of Betsy’s ECG without shortness of breath and nausea
The ECG shows ST segment depression, Q waves, and T wave inversion which whose rate
and rhythm are slightly irregular compared to when the patient is experiencing shortness of
breath and nausea.

ACUTE CORONARY SYNDROME 3
Question 2a: Pathophysiology of Angina
Angina is a chest pain which results from reduced flow of blood to the heart. It is one
of the primary symptoms of Coronary Artery Disease. It may also be referred as angina
pectoris which is always described as the pressure, squeezing, heaviness, pain, or tightness of
the chest. The primary cause of angina is myocardial ischemia which is caused by the
mismatch between the oxygen demand and myocardial blood supply or flow. The restriction
of the myocardial flow of blood results from the atherosclerotic narrowing of the epicardial
coronary artery, although vasoconstriction or abnormal vasodilation caused by impairment of
the endothelia functioning are also essential pathophysiological mechanisms behind the
development of angina (Ambrose, & Singh, 2015).
Some of the risk factors of angina include obesity, diabetes, stress physical inactivity,
hypertension, older age, positive history of heart disease in the family, high levels of
cholesterol in blood, and tobacco use either smoking, chewing or prolonged exposure to
passive smoking. The heart rate is one of the major determinants of myocardial ischemia
which principally results from the reduction of diastolic perfusion and increased myocardial
demand for oxygen (Palombo, & Kozakova, 2016).
One of the major symptoms of angina include chest discomfort or pain which is
possibly described as squeezing, pressure, fullness or burning. Other symptoms include
fatigue, nauseas, shortness of breath, dizziness, sweating, and painful neck, arms, jaw, back,
or shoulder which accompany chest pain. Stable angina results from exertion and is relieved
by resting (Thiruvoipati, Kielhorn, & Armstrong, 2015).
Unstable angina is considered as a medical emergency since it occurs unexpectedly
even when the patient is resting and its severe lasting for about 30 minutes above. Unstable
angina may not relieve with the use of medication or rest and its might be signal of heart

ACUTE CORONARY SYNDROME 4
attack. In unstable angina, the fatty deposits in the blood vessels rupture or a clot forms thus
blocking or reducing the flow via the narrowed artery. Consequently, this severely and
suddenly decreases the blood flow to the patient’s heart muscles resulting in chest pain
(Nelson et al., 2015).
The nonSTEMI type of angina results from partial occlusion of the coronary
artery by a thrombus resulting in the reduction of coronary flow of blood which
consequently results in subendocardial ischemia. On the other hand, STEMI angina is
caused a complete obstruction of the coronary artery by a thrombus which completely
stops the coronary flow of blood causing transmural ischemia. The hallmark for all is
chest pain but it is more severe in STEMI compare to unstable angina and nonSTEMI
(Handler, Coghlan, & Brown, 2018).
Ischemia in both STEMI and nonSTEMI are associated with necrosis while the
unstable does not present with necrosis. Angina progresses from unstable angina which is
potentially reversible to the irreversible phase of cell death secondary to myocardial
infarction which is either nonSTEMI or STEMI. If left untreated, the outcome of angina is
negative since it results in life-threatening complications and conditions such as heart failure,
arrhythmias, and heart attack (Douglas et al., 2015).
Question 2b: Two risk factors specific to the case scenario of Betsy that increase her
risk of Acute Coronary Syndrome
1) History of hypertension and Type 2 diabetes
2) Past history of Coronary Artery Bypass Graft and Coronary Artery Disease
Question 3: Interpretation of Betsy’s ECG while experiencing shortness of breath and
nausea