Coronary Artery Disease: STEMI, NSTEMI, and Tenecteplase Analysis

This report provides a comprehensive overview of coronary artery disease (CAD), beginning with the pathophysiological events leading to atherosclerotic plaque formation in coronary arteries, emphasizing the role of hypercholesterolemia and endothelial injury. It then contrasts stable and unstable angina, highlighting their differences in symptoms, triggers, and severity. The report further differentiates between STEMI (ST-elevation myocardial infarction) and NSTEMI (non-ST-elevation myocardial infarction), explaining how ECG findings guide diagnosis and treatment. Finally, it details the mechanism of action (MOA) of Tenecteplase, a thrombolytic drug used to treat STEMI by dissolving blood clots, along with the necessary precautions and administration methods. The report emphasizes the importance of early intervention and provides relevant references to support the information presented.

Assessment

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................3
Pathophysiological event that lead to atherosclerotic plaque formation in a coronary artery.....3
Comparison and contrasting stable and unstable angina in coronary heart disease....................3
Comparison of STEMI with NSTEMI.........................................................................................4
4 MOA of Tenecteplase...............................................................................................................4
REFERENCES................................................................................................................................6

Pathophysiological event that lead to atherosclerotic plaque formation in a coronary artery
In regard to proper functioning of body it can be said that there is requirement of
continuous supply of oxygen in heart and it can be done by coronary arteries. Margaret, 52 year
old woman facing problems like chest pain and it was causes of unhealthy diet that lead to
elevated blood cholesterol. In regard to atherosclerosis plaque formation it can be said that it
happens because of hypercholesterolaemia. Atherosclerosis that is also known as hardening of
the arteries that mainly happen when both cholesterol and calcium build up inside the lining of
the artery wall Asada & et.al., (2020). This substance that it forms is known as plaque. As per the
pathophysiological study, atherosclerosis can lead to endothelial injury. In regard to Margaret it
can be said that, this process or plaque formation started to build because of unhealthy diet
because heart requires blood and oxygen but due to oily and junk foods, cholesterol level
increases. It leads to lipid retention, oxidation as well as modification that blocks or provoke
chronic inflammation in the walls of arteries Peng & et.al., (2019) . So, it can easily be said that
due to increasing age, cholesterol level due to unhealthy diet, calcium started to collect in arteries
that build up a plaque and became reason of chest pain in Margaret.
Comparison and contrasting stable and unstable angina in coronary heart disease
Angina in simple term refers or known as chest pain. It may be stable and unstable.
Stable angina or chest pain occurs in people when they exert themselves physically and feel
stress. This angina or chest pain when it happens predictably then it does not worsen with time
and also does not change in frequency Cui & et.al., (2018). On the other hand, unstable angina or
chest pain happens when heart of people do not get enough blood flow as well as oxygen. It may
be severe and lead to heart attack. Similarity between both is as they both are considered as heart
attack.
The main difference between stable and unstable angina is, stable angina or chest pain
occur when people do physical activity, or they push themselves physically. It goes away when
they take rest and medications, Whereas, unstable chest pain occurs when people are on rest
mode or resting rather doing physical activity. So, from this difference it can easily be said that
unstable angina is critical or severer than stable because it happens due to blood clots or
blockage in arteries Eleonora & et.al., (2020).

Symptoms of unstable angina are: nausea, discomfort in chest, shortness of breathing.
Stable angina last only 5 minutes. It can be said that Margaret had unstable or severe chest pain
or angina.
Comparison of STEMI with NSTEMI
STEMI is a severe heart attack because of complete blockage in artery that is the main
part for supplying of oxygen and blood. It is ST-elevation myocardial infarction. There is a long
interruption to the blood supply and it causes severe damage to large area of heart. Whereas,
NSTEMI stands for non-ST-elevation myocardial infarction Kingma, (2018).
It can be better understood with the ST segment, presents in heart. This segment is a
portion of the ECG cycle, represents the beginning of ventricular repolarization. On the basis of
report of electrocardiography, this segment can be seen and measure and on the basis of this
report, doctor give medications to people and consider whether there is a STEMI or NSTEMI.
When pre hospital team conducted ECG of Margaret then it showed this ST segment elevation
and from this it can be said that she is facing from severe chest pain that requires urgent
treatment and medications otherwise it can lead to severe problems Karwowski & et.al., (2017).
4 MOA of Tenecteplase
STEMI is a heart disease, which causes a bad heart attack, due to STEMI the major
artery of the heard got blocked thoroughly. In other heart attacks the artery get blocked up to 80
to 90 percent but in case of STEMI, 100 percent artery gets blocked(Trabattoni and et.al, 2020).
Margaret is facing STEMI disease due to the unhealthy diet and therefore Margaret felt pain in
chest, which is a symbol of heart attack. To reduce the effect of STEMI, tenecteplase has been
made. Tenecteplase is thrombolytic drug which is being used to disintegrate unnecessary blood
clots. This is one of the best treatment for the patients who are suffering form STEMI disease.
Tenecteplase help in removing the blocked artery which is one of the reason that this drug used
for the treatment of STEMI.
But there are some precautions which has to be taken before taking this drug as there
should not be bleeding inside the body, high and uncontrolled blood pressure, any genetic
disorder which affects the brain and blood vessels, any disease which is related to kidney besides
this any eye problem or pregnancy etc. sop theses are the major things which have to be
considered before giving this drug to the patient. Besides this, there is a specific way of giving
this drug to patient so that, they can recover from STEMI, this drug is generally given to the

patient after the first sign of heart attack, in the case of Margaret, she has also given this drug
earliest after seeing the heart attack so that her 100 percent artery don't get blocked, and she can
survive. This drug has been given in the form of an injection, and one dose of this drug has to be
given on daily basis(Warach and et.al, 2020). But this drug can increase the risk of bleeding,
which can put a negative impact on the life of the patient so before giving this drug to any
patients, it is to make sure that they are not suffering from bleeding. But this drug is helpful to
recover from STEMI as it helps the body to produce new blood clots and reduces the risk of
brokerage of artery, when the brokerage in artery get stopped, the patient can fight against the
STEMI, and can recover from this life threatening disease. In the case of Margaret, Tenecteplase
drug can be suggested as it will helpful to recover from STEMI.

REFERENCES
Books and Journals
Asada, Y. & et.al., (2020). Pathophysiology of atherothrombosis: mechanisms of thrombus
formation on disrupted atherosclerotic plaques.Pathology international. 70(6). 309-322.
Cui, Y. & et.al., (2018). Plasmatic microRNA signatures in elderly people with stable and
unstable angina. International heart journal. 59(1). 43-50.
Eleonora, T. & et.al., (2020). Role of immuno-inflammatory reactions in the pathogenesis of
clinical variants of coronary heart disease. Journal of Critical Reviews. 7(1). 189-191.
Karwowski, J. & et.al., (2017). Relationship between infarct artery location, acute total coronary
occlusion, and mortality in STEMI and NSTEMI patients. Polish archives of internal
medicine. 127(6). 401-411.
Kingma, J. G. (2018). Myocardial Infarction: An Overview of STEMI and NSTEMI
Physiopathology and Treatment. World Journal of Cardiovascular Diseases. 8(11). 498.
Peng, Z. & et.al., 2019. Endothelial response to pathophysiological stress. Arteriosclerosis,
thrombosis, and vascular biology. 39(11). pp.e233-e243.
Trabattoni & et.al, (2020). Late STEMI and NSTEMI patients’ emergency calling in CoVID-19
outbreak. Canadian Journal of Cardiology. 36(7).pp.1161-e7.
Warach and et.al, (2020). Tenecteplase Thrombolysis for Acute Ischemic Stroke. Stroke.
51(11).pp.3440-3451.