Heart Matters: ACS: A triad of troubles sets the stage for MI
Natalie Bermudez MSN, RN

Nursing Made Incredibly Easy!
December 2012 
Volume 10  Number 6
Pages 14 - 17
  PDF Version Available!

Mr. O, 55, presents to the ED complaining of intermittent sharp chest pain and "heaviness," with discomfort radiating to his jaw and shortness of breath. He says he has been feeling this way for the past few hours and was sitting in his recliner watching TV at the time of onset. He has a history of hyperlipidemia, but he isn't taking any medications to treat it. He has been smoking since he was 18 and estimates smoking about 2 packs a day. He reports that his father died of a myocardial infarction (MI) at age 63. He doesn't visit a primary healthcare provider regularly.His 12-lead ECG is negative for ST-segment elevation, but his cardiac biomarkers are positive. Administration of I.V. nitroglycerin at 20 mcg/minute and morphine sulfate 2 mg relieves his chest pain. He also receives a baby aspirin. Mr. O is admitted to the coronary care step-down unit with a diagnosis of non-ST elevation myocardial infarction (NSTEMI) for further evaluation and treatment.Although Mr. O is stable now, the stage may be set for an MI. His condition is associated with a coronary occlusion triad-plaque rupture, thrombus formation, and vasoconstriction-that could be fatal without intervention. Here's how to bring down the curtain on this dangerous situation before his condition worsens.Acute coronary syndrome (ACS) is an umbrella term used to describe occlusive or partially occlusive coronary vascular events known as unstable angina (UA), NSTEMI, and ST-segment elevation myocardial infarction (STEMI). These terms describe three severe stages of coronary occlusion that result in insufficient or complete lack of perfusion to myocardial tissue (see ACS tissue destruction).The type of ACS is diagnosed based on partial, intermittent, or complete occlusion of coronary vessels, which can be rapidly determined through a 12-lead ECG and serum cardiac biomarkers. Troponin (I or T) levels are the preferred cardiac biomarker for evaluation of ACS because they're the most specific indicator of myocardial

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