Acute Coronary Syndrome

The condition is characterized by pains in the chest and it is typically confirmed inside the hospital or the emergency room. It is also manageable if immediately confirmed. Acute syndrome occurs when plaques inside a narrowed vessel of blood splits causing thrombus development. This will consequently lead to unexpected partial or full blockage. The thrombus may also dislodge from a broken plaque consequently blocking the blood vessels. Explain risk factors Acute coronary syndrome may occur gradually in the long run by the plaques formation inside the arteries of the heart.

The plaques comprise of fatty plaques that cause arterial stenosis making it difficult for the blood to pass through. Formation of this plaque is called atherosclerosis which signifies that the heart cannot pump sufficient oxygenated blood to the whole body subsequently leading to a heart attack or chest pains.

If one of the plaques inside the blood vessels of the heart is dislodged, heart attack may occur. Coagulation of blood will take place in the area where it dislodged, preventing the circulation of blood to the particular artery. Some of the factors of risk of acute coronary syndrome encompass elevated blood pressure, aging, elevated blood cholesterol, sedentary lifestyles, cigarette smoking, family history and diabetes type 2. The risk factors of acute coronary syndrome involve the following:Clinical ManifestationsKnowing the acute coronary syndrome symptoms is crucial since it might save a life.

A heart attack can occur if the condition is left untreated. Some of the clinical manifestations of acute coronary syndrome include

• Pains in the chest that is characterized by heaviness, burning feeling which persists for a few minutes or longer;
• Nausea and vomiting ;
• Breathing difficulty ;
• Pain sensation in other parts of the body such as the left jaw or upper arm;
• Sudden and heavy sweating.

Unusual symptoms such as nervousness, abdominal area pain, fainting, moist skin and pain akin to heartburn may also be experienced. PathogenesisPathogenesis of acute coronary syndrome may manifest from a new superimposed thrombosis on a pre-existing vasospasm of either one or more coronary arteries. The acute plaque role also changes. In majority of patients, infarction, unstable angina and numerous SCD cases all take manifest due to sudden change that is followed by thrombosis. Thrombosis over plaque take place as a result of two diverse processed.

One of the processes is as a result of an extension of the endothelial denudation process so that large surface areas of the subendothelial connective tissue might be exposed (Davies, 2000). The process is refered to as endothelial erosion. The loss of the endothelial cells might be as a result of macrophages proximity.

These macrophages are well activated and cause death of endothelial cells by the process known as apoptosis and also the by the proteases production that cut loose the endothelial cells from their linkage to the vessel wall. Evaluation and treatmentThere are diverse diagnostic tests to confirm an angina or heart attack Electrocardiogram (ECG)ECG is the initial test conducted to confirm an occurrence of heart attack and it is frequently performed while the patient is interviewed regarding the symptoms (American College of Sports Medicine, 2013). This assessment takes not of the hearts movement by electrodesmeans stuck to the patients skin. Impulses are then noted as waves demonstrated on a printed paper or on the screen. Since a damaged muscle of the heart does not usually conduct electrical impulses, the electrocardiogram may indicate that a heart attack has occurred or is occurring.

Blood testsIn this evaluation method, specific enzymes of the heart steadily seep out of the blood if the heart has been injured due to a heart attack. Blood will be taken to confirm if the enzymes are present. If the blood displays negative heart attack markers and the chain pain has diminished, then the patient will have tests to confirm the circulation of blood through the heart. Coronary angiogramCoronary angiogram can assess if the coronary arteries are either obstructed or narrowed. A liquid dye is places into the heart arteries with a catheter that will pass inside an artery, into the leg toward the arteries of the heart. As the dye continues to fill the arteries, the arteries become observable on x-ray, displaying occlusion sites.

Echocardiogram

Echocardiogram will be done before the patient leaves the hospital if the physician concludes that there were no indications of a heart attack. This diagnosis uses sound waves to create a picture in the patients heart. It can assist is confirming whether a particular area of the heart has been injured as a result of a heart attack or is not properly working. Chest X-rayAn X-ray picture of the patients chest lets the physician to verify the shape and size of the heart together with its blood vessels. Computerized tomography (CT) angiogramThis diagnosis test lets the physician ensure that the arteries are not obstructed or narrowed.

CT angiogram is only conducted if the examinations of the blood and electrocardiogram do not display the origin of the symptoms. TreatmentAcute coronary syndrome treatment differs on the biases of the patients symptoms and how obstructed the arteries of the patients are. MedicationsPhysicians will prescribe drugs that can mitigate the pains in the chest and enhance the circulation of blood in the heart. Some of the medications include aspirin that is indicated to reduce the coagulation of blood and keep the circulation of blood inside the narrowed arteries of the heart (Slaughter et al., 2010). Thrombolytics also referred to as clot busters are indicated to aid in dissolving of blood clot which is obstructing the circulation of blood to the heart. Nitroglycerin also widens narrowed arteries thus enhancing circulation of blood to and from the heart. Beta blockers is indicated to relax the muscles of the heart, slow the heart beat and decrease the blood pressure which decreases the heart demand.

ACE inhibitors and ARBs let blood flow from the heart with ease. They also decrease the pressure of the blood and may avert a second heart attack. Cholesterol-lowering drugs decrease the levels of cholesterol leading to less deposits of plaque. Calcium channel blockers are used in relaxing the heart and allow more blood to flow to and from the heart. Clopidogrel is used to help in avoiding blood clots from forming.Compare angina to myocardial infectionA myocardial infarction is a grave condition characterized by complete blood supply blockage to the heart. Angina on the other hand is a chest pain or discomfort that usually takes place with stress or activity due to poor flow of blood through the blood vessels in the heart.

Myocardial infarction is a heart attack which happens when the vessels of the blood that supply blood to the coronary arteries are blocked. This can result to serious damage to the heart and lead to an abnormal rhythm of the heart or heart failure. Myocardial infarction is caused by plaque also referred to as fatty deposits which can build inside one or more of the heart vessels. This can result to the arteries becoming narrow or block the flow of blood. There is also a probability of small pieces breaking off and blocking flow of blood. MI can also be caused by heart spasm. This is when a coronary artery abruptly stops or tightens the flow of bloods to some heart muscles part. Angina on the other hand is caused by narrowing and hardening of the major blood vessels going to the heart. This consequently restricts supply of blood to this major organ. Like all the organs and tissues in the body, the heart requires constant supply of blood that is rich in oxygen in order for it to conduct normal functions. Coronary arteries aid flow of blood in the heart. The walls of these arteries can become covered with deposits of fat with time, a process referred to as atherosclerosis. The fatty deposits are referred to as atheroma.

Correlate the above information to this clients clinical situationbased on the medication that the client was taking at home, what other health issues did the client have?Based on the Ramipril that the patient was taking at home, the patient had high blood pressure. Ramipril is an angiotensin converting enzyme inhibitor that is used in the treatment of high blood pressure and heart failure. Ramipril is also used in preventing kidney failure as a result of diabetes and hypertension.

The patient was also taking diamicron. This indicates that he had diabetes type  Diamicron belongs to oral hypoglycemics and is used in the control of glucose in individuals with type 2 diabetes. The medicine is usually used when exercise, diet and reduction of weight have been found not able to adequately control blood glucose levels without medication. This gliclazide MR augments the insulin amount released by the pancreas and aids the body in using insulin efficiently. There was also indication of bronchitis or chronic obstructive pulmonary disease due to use of the spriva 18 mcg inhaler. This inhalation powder is an anticholigernic drug used to avert bronchospasm or narrowing of the lungs? airways. The spriva inhaler helped relax the airways and keep them open. Use of atorvasatin also meant that the patient had high cholesterol. The drug reduces bad cholesterol levels and triglycerides in the blood while increasing the good cholesterol levels. Atorvastatin is used in the treatment of high cholesterol and to decrease the risk of heart attack, stroke, or other complications of the heart in individuals with coronary heart disease, diabetes or other risk factors.

Analyze the laboratory results. What are the expected ranges of each lab test and identify the abnormal results.White blood cells 4.6 * 109/L Normal levels of white blood cells (WBC) may vary slightly from one lab to another. The normal white blood cells number in the blood is 4.5 to 11.0 — 109/L. Red blood cellsThe normal red blood cell range for men is 4.7 to 6.1 million cells per microliter (Medenhall et al., 2012). The patients red blood cell count is slightly lower. The lab test indicated that his RBC count is 4.09 — 1012. A decreased count in the red blood cells indicates loss of blood, reduced red blood cell production as a result of deficiency of folic acid or anemia. It could also been an indication of deficiency of B12. HemoglobinThe normal range of hemoglobin for men is 133-127 g/L.

The patients hemoglobin was 131 g/L thus falling slightly lower than the normal range. This is an indication of anemia probably due to a decreased red cell mass or augmented volume of plasma. Anemia in the patient may be as a result of mitigated production or augmented loss of red blood cells. Sodium lab testNormal sodium levels are usually between 136 and 145 millimoles per litre. Sodium levels in the blood below 136 mmol/L, may mean that the patient is suffering from hyponatremia or decreased blood sodium and excess water in the body. Therefore, the sodium levels of 137 mmol per litre in the patient, is normal since it falls in the normal sodium range. Potassium lab testIn regards to potassium levels, the normal levels in the blood is 3.5 to 5.5 mEq/L.

The patients potassium level is 4.2 mmol/L. This indicates that his levels are normal.Troponin The troponin level of the patient is 0.02 ng/ml at 1630 hrs. However, his troponin level at 1600 hrs is 0.76 ng/ml. At 0.76 ng/ml, the level of troponin was elevated which a significant indicator of heart damage until was proven otherwise. This heart attack might have occurred as a result of a blockage or as a result of other conditions that placed strain on the heart such as critical illness or heart failure. The troponin level that is a significant indicator of heart attack is the level above the reference or normal range. 0.76 was above the normal range which could mean damage of the heart. Chloride 100mlThe normal blood chloride range is between 96 and 106 milliequivalents of chloride per blood litre. Level of chloride that is above the normal range means that there is excess level of chloride in the blood, a condition called hyperchloremia. MagnesiumAccording to the lab tests, the patient has a magnesium level of 0.58 mmol/L. T

hus, the patient is suffering from hypomagnesemia, an electrolyte imbalance marked by low levels of magnesium in the blood. The normal range for magnesium is 1.5-2.5 mEq/L. Magnesium is one of the many electrolytes found in the body. Normal magnesium levels are crucial for the heart and nervous system function maintenance. Creatine KinaseThe creatine kinase level of the patient has been found to be 230 after the lab test evaluation. A 230 creatine kinase level is just barely above the normal upper limit. However, it could mean a very minor muscle damage amount. This might be an indication of autoimmune hemolytica anemia which might cause a small muscle damage amount and a small amount of damage to the liver. Explain the clinical significance of these tests.These clinical lab tests are important since they offer the primary basis for acute coronary syndrome diagnosis. These clinical tests may also determine whether the condition can be classified as an unstable angina or a heart attack. 2. Review the medication ordered for the client while in hospital. Briefly describe these medications and state why these medications have been orderedlovenox 100mg subcut dailyLovenox also known as enoxaparin is an anticoagulant that aids in averting blood clots formation.

Lovenox is used in the treatment or prevention of blood clots known as deep vein thrombosis that can consequently lead to blood clots in the lungs. A deep vein thrombosis can occur to people that are bed-ridden as a result of prolonged illness or after certain surgery types. The drug is also used in preventing complications of the blood vessel in individuals with different types of chest pains (angina) or heart attack. Therefore, this medication might have been ordered to reduce the chest pains that the patients had. TectaTecta, also known as Pantoprazole magnesium belongs to the proton pump inhibitors group (PPIs). PPIs are used in the treatment of conditions where stomach acid reduction is required such as duodenal ulcers, stomach ulcers, gastroesophageal reflux disease symptoms and reflux esophagitis. Tecta is also used along with antibiotics in the treatment of duodenal ulcers that are caused by H. pylori bacteria.

The drug works to mitigate the acid amount the stomach produces by blocking the enzyme action that releases acid in the stomach. Therefore, tecta might have been given to mitigate the amount of acid in the stomach of patient. Nitrodur patchNitrodur patch is used in the prevention of chest pain or angina in individuals with particular heart condition or coronary artery diseases (Sirbu & Linton, 2017). The medication belongs to a class of drugs referred to as nitrates. The chest pains occur when the muscle of the heart is not receiving adequate blood. The drug functions by widening and relaxing blood vessels so that blood can flow more efficiently to the heart. Sliding scale insulinSliding scale refers to the progressive surge in the nighttime or pre-meal dose of insulin on the basis of pre-defined ranges of blood glucose. The regimen of sliding scale insulin approximates the daily requirements of insulin. It is used in the management of diabetic patients.

References

• American College of Sports Medicine. (2013).
• ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.Davies, M. J. (2000).
• The pathophysiology of acute coronary syndromes.? Heart,? 83(3), 361-366.Kumar, A.,  Cannon, C. P. (2009, October).
• Acute coronary syndromes: diagnosis and management, part I. In? Mayo Clinic Proceedings (Vol. 84, No. 10, pp. 917-938).
• Elsevier.Mendenhall, W., Beaver, R. J.,  Beaver, B. M. (2012).
• Introduction to probability and statistics. Cengage Learning.Slaughter, M. S., Pagani, F. D., Rogers, J. G., Miller, L. W., Sun, B., Russell, S. D., Adamson, R. M. (2010).
• Clinical management of continuous-flow left ventricular assist devices in advanced heart failure.
• The Journal of Heart and Lung Transplantation,? 29(4), S1-S39.Sirbu, M. C., & Linton, J. C. (2017).
• Cardiovascular Disease: Medical Overview. In? Practical Psychology in Medical Rehabilitation (pp. 211-218).

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