Acute Coronary Syndrome: Pathophysiology, Diagnosis, and Treatment

Running Head: ACUTE CORONARY SYNDROME
ACUTE CORONARY SYNDROME

ACUTE CORONARY SYNDROME
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INTRODUCTION
Angina pectoris is a medical condition characterised by chest pain and discomfort due
to coronary heart disease. In the following assessment, the pathophysiology of the condition
has been briefly discussed. The types of angina pectoris and rationale of carrying out an ECG
has also been discussed. Various abnormal interpretations in the ECG of the patient have also
been examined. In the assessment, various important factors which can be helpful in the
diagnosis of coronary heart syndrome have also been identified. In addition, the mechanism
of action of drugs as well as the relation between depression and chronic illnesses have also
been explained.
QUESTION 1
RATIONALE FOR ECG REQUEST:
The buddy nurse has asked Betsy for ECG even though she has no history of chest
pain. ECG is required in this case because Betsy has a past history of Coronary Heart disease,
Coronary artery bypass graft, and Chronic obstructive pulmonary disease. ECG is also
recommended for examining patients experiencing shortness of breath, dizziness, etc.
Through ECG doctor measures how long does an electric wave take to pass through the heart,
through which they analyse the activity and size of the organ? Hence ECG would be helpful
in examining the condition of Betsy's heart.
QUESTION 2
PATHOPHYSIOLOGY OF ANGINA:
Betsy is diagnosed with Angina Pectoris, which is characterised by extreme chest
pain. It is the consequence of myocardial ischemia which is mainly caused by a disturbance
in the balance between oxygen demand and myocardial blood supply. Atherosclerosis is one
of the main cause which leads to angina pectoris. It is a condition in which plaque
accumulates inside arteries that restrict the flow of oxygen-rich blood to cardiac muscles.

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Plaque is mainly made up of cholesterol, fat and other substances found in the blood. To
compensate for the loss of oxygen-rich blood, heart muscles start working rigorously by
pumping blood to the muscles with more force, which results in the development of angina
pectoris. In order to compensate for oxygen loss, heart muscles start transitioning from
aerobic to anaerobic metabolism. According to Prisby, Adenosine is the key factor which
regulates the progression of Angina pectoris (Angina Pectoris, n.d.). It has been reported that
in order to dilate arteries to increase blood supply, adenosine triphosphate degrades during
low blood supply and diffuse in extracellular space. Which results in extreme chest pain.
There are many types of angina pectoris, some of which are as follows:
Stable Angina: Stable angina is characterised by pain in the chest or severe discomfort that
most commonly results from stress, anxiety or depression. It is caused by the restriction of
blood flow through the vessels to the heart.
Unstable Angina: Unstable angina is a type of angina pectoris which develops
spontaneously and unpredictably. Unlike other types, it is not triggered by any activity or
stressful condition.
NSTEMI Angina (Non-ST segment Elevated Myocardial Infarction): It is a type of
angina pectoris in which no ST-segment elevates in 12-lead ECG.
STEMI Angina (ST Segment Elevated Myocardial Infarction): It is a type of angina in
which manifestation of symptoms of angina occur as a consequence of cardiac necrosis. In
this type, ST-segment elevates in 12-lead ECG.
RISK FACTORS
The two main risk factors that are crucial in this case are; hypertension and type II
diabetes mellitus. According to researchers, these conditions are some of the major risk
factors for the development of acute coronary syndrome.
QUESTION 3

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INTERPRETATION OF ECG:
The ECG report of the patient shows the following characteristics,
Heart Rate: The heart rate of the patient is 100 beats per minute.
P Waves: These waves are present as well as regular.
ST segment: ST segment is elevated more the 0.1mv.
Sinus Rhythm: With a heart rate of 100 beats per minute, ECG is showing the condition of
Tachycardia.
The ECG of the patients shows that the patient is suffering from the complications of Inferior
wall MI with reciprocal changes.
QUESTION 4
DIAGNOSIS OF ACUTE CORONARY SYNDROME:
The disease is suspected when specific clinical criteria are met. Three of the most
crucial findings that confirm the diagnosis of the disease are as follows:
ST-Segment Elevation: According to National (2013), the ST segment is supposed to be
elevated when the blood supply to heart muscles got impaired due to thrombus formation in
the arteries. The prolonged elevation of ST segment leads to chronic complication of
Myocardial Infarction.
Sinus Tachycardia: It has been suggested that tachycardia is one of the manifestations of
acute coronary syndrome and can be resulted from dysfunction of the sinus node, withdrawal
of beta blockers, or super ventricular tachycardia ablation.
Increased Heart Rate: It has been reported that increased heart rate is also one of the clinical
manifestations of coronary heart disease. The heart rate is increased due to pumping blood
forcefully by cardiac muscles to compensate for the loss of blood and oxygen supply in the
cardiac muscles.
QUESTION 5