Download Acute Coronary Syndrome

Acute Coronary Syndrome
What is Acute Coronary Syndrome ?
How can I look at an EKG and tell what
part of the heart is affected ?
What do ICU RNs need to know ?
What is Acute Coronary Syndrome
(ACS) ?
Acute Coronary Syndrome is when occlusion of
one or more of the coronary arteries occurs,
usually following plaque rupture, resulting in
decreased oxygen supply to the heart muscle.
 ACS is the largest cause of death in U.S. Over 1
million people will have Myocardial Infarctions
this year; almost half will be fatal.
 Majority of mortality associated with ST
Elevation Myocardial Infarction (STEMI).
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Who is at risk for ACS?
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Anyone with history of CAD, HTN, ESRD, DM
Blood loss due to GI Bleed, surgery, trauma
Patients on dialysis with AV Fistulas (↑ myocardial
O2 demands)
Decreased O2 saturations (particularly in COPD)
Fever, hyperthyroidism, sustained tachycardia,
prolonged hypotension, hypothermia, DIC, drug use
(especially cocaine)
Who is at risk for ACS?
Conditions that may mimic ACS include:
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Musculoskeletal chest pain
Pericarditis (can have acute ST changes)
Aortic dissection
Central Nervous System Disease (may mimic
MI by causing diffuse ST-T wave changes)
Pancreatitis/Cholecystitis
The Three I’s

Ischemia= ST depression or T-wave inversion
Represents lack of oxygen to myocardial tissue
The Three I’s
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Injury = ST elevation -- represents prolonged
ischemia; significant when > 1 mm above the baseline
of the segment in two or more leads
The Three I’s
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Infarct = Q wave — represented by first
negative deflection after P wave; must be
pathological to indicate MI
What part of the heart is affected ?

II, III, aVF =
Inferior Wall
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Inferior Wall MI
Based on the EKG, which vessel in the
heart is blocked?

II, III & aVF = Inferior Wall MI =
Right Coronary Artery
blockage
Which part of the heart is affected ?
• Leads V1, V2, V3, and V4 =
Anterior Wall MI
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Anterior Wall MI
Based on the EKG, which vessel in the
heart is blocked?
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V1 - V4 = Anterior Wall
(Left Ventricle) =
Left Anterior
Descending Artery
Blockage
What part of the heart is affected ?

I, aVL, V5 and V6
Lateral wall of left ventricle
I
aVR
V1
V4
II
aVL
V2
V5
III
aVF
V3
V6
Lateral Wall MI
Based on the EKG, which vessel in the
heart is blocked?

I, aVL, V5 + V6 =
Lateral Wall =
Circumflex Artery
Blockage
What do ICU RNs need to know?
You should do a 12-Lead EKG when:
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A patient who has CAD risk factors complains of
Chest Pain
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When you are analyzing your rhythm strip on the
flowsheet, and you notice that it looks different
from the previous shift; OR any arrhythmias or
changes in rhythm
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If your patient who is intubated / sedated
suddenly begins to have hemodynamic changes
putting stress on the heart + lungs
What do ICU RNs need to know?
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Unexplained tachycardia
Tachypnea
Sudden elevation in PA catheter #’s or ICP
(unexplained)
Nausea and/or diaphoresis that doesn’t make
sense
Pallor
Symptoms of sudden heart failure (pulmonary
edema/crackles)
Unexplained restlessness/all of a sudden
needs more sedation
Summary
After completing an EKG, look at each
of the leads for ST segment changes
 Remember the three I’s:
Ischemia, Injury, and Infarct !!
 Identify the section of the heart (and
vessel supplying it) affected by the
blockage according to the groups of
leads changing in the EKG
 Remember the symptoms that would
prompt you to obtain an EKG!
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