Acute coronary syndrome?? is a condition that involves chest discomfort that can result in a lack of oxygen to the heart muscle (myocardium).

 Acute Coronary Syndrome

The acute coronary syndrome is a condition that involves chest discomfort that can result in a lack of oxygen to the heart muscle (myocardium). The acute coronary syndrome is a collection of manifestations/symptoms that can be caused by coronary artery disorders. Acute coronary syndrome is a disease factor by atherosclerotic plaque through platelet aggregation and its shape is like an intra-coronary thrombus plaque.

A. Causes of coronary syndrome

This acute coronary syndrome can lead to complications in coronary artery plaque buildup. The acute coronary syndrome is caused by the heart not being able to pump enough blood because of oxygen throughout the body, causing chest pain (angina).

The acute coronary syndrome can occur in arterial plaque so that blood vessels rupture and cause blood clots.

B. Signs & Symptoms

- Chest pain in the equivalence angina criteria is not all types in the emergency room.

- Tachycardia resulting in sympathetic stimulation

- Pain in the left hand and jaw.

- Chest pain feels like pressure or tightness

- Nausea and vomiting.

C. Pathophysiology

The acute coronary syndrome is an acute manifestation of atheroma/plaque of ruptured coronary arteries. This thrombus can block through the coronary arteries partially / microemboli can occlude the entire distal coronary artery.

This coronary syndrome can be reduced coronary blood flow caused by myocardial ischemia. Acute coronary syndrome can cause a local spasm of the arteries through the epicardial coronary (Prinzmetal's angina).

D. Classification of Acute Coronary Syndrome

Acute st-segment elevation myocardial infarction is an indicator of coronary artery occlusion. Examination of these cardiac markers can increase the diagnosis of non-elevation st-segment acute myocardial infarction.

Acute coronary syndrome aims to increase the abnormal CK-Mb is a unit that is more than the upper normal value. If the initial EKG examination shows normal abnormalities or non-diagnostic abnormalities of angina are still direct, the examination is repeated again for 10-20 minutes.

E. Diagnosis of acute coronary syndrome

1. History of patients with myocardial ischemia can get chest pain.

2. Typical angina, feeling depressed/heavy retrosternal area radiating to the left hand, neck, interscapular area, shoulder, and epigastrium lasting intermittent/persistent for 20 minutes.

3. Angina can occur during daily activities

4. Post-infarction angina

5. Angina at rest for 20 minutes

F. Diagnostic check

1. Electrocardiogram (ECG) examination to distinguish stemi and ska 1

2. Check heart markers

3. Chest X-ray to check the enlargement of the heart or not.

4. Laboratory tests such as blood tests, blood sugar, electrolyte status, blood coagulation, kidney function tests and lipid panels.

G. Complications of acute coronary syndrome

1. Cardiogenic shock

2. Malignant arrhythmia

3. Gaga's heart

4. Delivery interruption

H. Classification of acute coronary syndrome

- Class 1 Evidence of mutual agreement for this treatment to be highly effective.

- Class II evidence or differing income regarding medicinal use.

- Class III collective agreement that this treatment is not used or is not effective so it is likely to be dangerous.

- Level of evidence A: These data are from a double-randomized clinical study.

- Level of evidence B This data is from one of the non-randomized studies.

- Level of evidence c This data is from a census of expert opinion.

I. General actions and initial steps

1. Bed rest (grade 1-c)

2. Supplemental oxygen should be given with arterial 02 saturation <95%.

3. Supplemental oxygen can be given to patients who experience ska for 6 hours

4. Aspirin 160-130 mg given to the patient.

5. Nitroglycerin (NTG) sublingual spray/tablet for patients with chest pain.

6. Morphine sulfate 1-5 mg intravenously repeated every 10-30 minutes.

J. Risk Factors of acute coronary syndrome

- Lack of physical activity

- High blood pressure

- High cholesterol

- Type 1 diabetes

- Smoking


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