Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)

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Study Tools For Acute Coronary Syndromes (MI-ST and Non ST, Unstable Angina) for Progressive Care Certified Nurse (PCCN)

Acute Coronary Syndrome (ACS) (Cheatsheet)

Acute coronary syndrome (ACS): the suspicion or confirmed
presence of acute myocardial ischemia caused by POOR
PERFUSION
Caused by clots, narrowed coronary arteries or vasospasms
and damages the myocardium (heart muscle)
Acute coronary syndrome may be further classified into the
following categories:
- Unstable angina
- NSTEMI
- STEMI

Unstable Angina
- Partial Occlusion of coronary artery
- “Traffic cones in the road”
- No damage to myocardium
NSTEMI
- Partial occlusion of coronary artery
- “One lane closed in the highway”
- Damage to myocardium: inner layer only
STEMI
- Complete occlusion of coronary artery
- “All lanes washed away – no road!”
- Affects ALL layers of heart muscle

ECGS = ACS Type/Location
- ECG Timing
  - ECG within 10 minutes of ED arrival.
  - Repeat every 15 minutes or so
NSTEMI
- ST Depression
- T wave inversion
STEMI
- ST Elevation
- Hyperacute T waves
Priority Labs = Troponin
- Troponin Timing ‘Drawn Serially”
  - Higher the troponin = worse the damage
  - Starts rising 3-6 hours after an MI
  - Peak 16 hours
  - Normal in 2 weeks
    - “Normal” = 0.04 ng/ml
- Troponin determines ACS Type/Damage Extent
  - Unstable Angina = NEG Trop
  - NSTEMI = POS Trop
  - STEMI= POS Trop

Priority Pharmacological Interventions
- Oxygen
  - If symptomatic
- Nitrates
  - 0.4 mg SL Q 5 mins x 3
- Aspirin
  - Platelets less sticky
- Morphine
  - Dosing = low & slow
Priority Non-Pharmacology
- IV Access
- Vitals
- EKG results = intervention
  - Unstable Angina = Heparin gtt
  - NSTEMI = Heparin gtt → Cath Lab
  - STEMI = CATH LAB
STEMI = Cath Lab
- PCI (stent) in 90 mins
  - Clot Busters if not available (if not contraindicated)
- GOAL = RESOLVE chest pain

When you start a FREE trial you gain access to the full outline as well as:

Collet J-P, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; 42(14):p.1289-1367. doi: 10.1093/eurheartj/ehaa575.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. J Am Coll Cardiol. 2021; 78(22): p.e187-e285.
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2017; 39(2): p.119-177. doi: 10.1093/eurheartj/ehx393
Ralapanawa, U., & Sivakanesan, R. (2021). Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: A narrative review. Journal of Epidemiology and Global Health, 11(2), 169.
Wereski R, Kimenai DM, Taggart C, et al. Cardiac Troponin Thresholds and Kinetics to Differentiate Myocardial Injury and Myocardial Infarction. Circulation. 2021; 144(7): p.528-538. doi: 10.1161/circulationaha.121.054302