Case Study: Betsy's Care in Acute Coronary Syndrome

Bachelor of Nursing

Introduction:
In this assignment, case of Betsy is being discussed. She is 72 years old with multiple
complications like cardiovascular, respiratory and metabolic complications. Moreover, she is
consuming multiple medications; since, she is associated with multiple disease conditions. In
this essay, different aspects related to her care will be discussed like pathophysiology of the
disease condition, risk factors associated with the disease condition, interpretation of
diagnostic data like ECG and clinical criteria for the disease condition. Moreover,
medications will be discussed in terms of class of drug, mechanism of action, side effects and
nursing consideration during administration of medications. Benefits and risk factors of
administration of ticagrelor, aspirin and morphine will also be discussed. Depression
associated with coronary heart disease will also be discussed.
Body:
Question 1 :
Coronary artery disease (CHD) is the narrowing of the coronary arteries which supply
oxygen and blood to the heart. CHD mainly occur due to accumulation of cholesterol on the
artery walls which create plaques. Hence, there would be inadequate arterial blood flow.
Normal ECG pattern changes during inadequate coronary artery blood flow. ECG is useful in
determining rate and rhythm of the heartbeats. Changes in the heart is associated with new
coronary artery events which can be effectively monitored through ECG. Hypertension is an
asymptomatic disease. However, ECG is useful in identifying cardiac electrical remodelling
which provide significant information related to disease stratification. ECG in hypertensive
patients also be useful in identifying damage to heart or blood vessels. Since, Betsy is
associated with cardiovascular conditions; it would be helpful to carry out her ECG. ECG in
Betsy would be helpful in identifying cholesterol clogging during blood supply to heart, heart
attack in the past, heart enlargement at one side and abnormal heart rhythms (Darpo, 2015;
Burke, Wang, Blease, Levy, and Magnani, 2014).
Question 2 :
2a) Angina mainly occur due to imbalance in the heart’s oxygen demand and supply.
Atherosclerotic plaques are mainly responsible for the impeded blood flow. Obstruction in
the blood flow can be fixed or dynamic as in atherosclerosis or coronary spasm respectively.

In unstable angina, vulnerable plaque formed. Tissue factor is present within the necrotic core
of the plaque. After exposure to blood, clotting cascade gets activated and thrombosis occur.
After the disruption of fibrous cap, tissue factor gets exposed.
Coronary occlusion due to plaque rupture or erosion is mainly responsible for the occurrence
Angina. Rupture or erosion resulting in coronary occlusion is the predominant mechanism in
Non-STEMI and STEMI. Unstable angina and NSTEMI occur mainly due to same
pathophysiological mechanism which result in unstable atherosclerotic plaque which lead to
non-occlusive thrombus or complete thrombosis formation. In NSTEMI, partial or temporary
blockade occurs which results in relatively small damage (Ando, Takagi, and Grines, 2017).
STEMI mainly occur due to unexpected and prolonged blockage of the blood vessels which
affects large area of heart muscles. In STEMI, plaque rupture is the prominent mechanism
followed by plaque erosion. In case of NSTEMI, plaque erosion is the prominent mechanism
followed by plaque rupture. Plaque rupture is associated with lipid rich plaque, collagen poor
plaque, macrophage rich inflammation and fibrous cap. Plaque erosion is associated with
plaque with extracellular matrix, proteoglycan, glycoaminoglycan; however, without
inflammatory cells, no fibrous cap and no large lipid core (Tousoulis et al., 2013).
2) Hypertension and type 2 diabetes mellitus are the risk factors associated with acute
coronary syndrome in Betsy.
Question 3 :
Betsy’s ECG is exhibiting regularly irregular rhythm. This regularly irregular heart rhythm
indicates heart block. Spaces between the R and R are useful in interpreting rhythm in the
ECG. Equal spaces between R and R indicate normal heart rhythm; however unequal spaces
between the R and R indicate irregular rhythm. Heart rate from the Betsy’s ECG need to be
calculated by measuring number of R waves in 6 seconds and multiplied by 10. This formula
should be used to calculate heart rate in this case because Betsy is exhibiting irregular
rhythm. Since, Betsy is exhibiting irregular rhythm; heart rate is more than 100 beats per
minute which is higher than the normal heart rate. ST segment depression was observed in
case of Betsy’s ECG. Depression of ST segment indicate NSTEMI, myocardial ischemia and
posterior myocardial ischemia. Presence of irregular P wave indicate atrial flutter with
variable block (Klabunde, 2017; Burke, Wang, Blease, Levy, and Magnani, 2014).
Question 4 :