SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY

for ACUTE CORONARY SYNDROME

NON-ST ELEVATION MYOCARDIAL INFACTION (ACS—NSTEMI)

PRECIPITATING FACTORS: PREDISPOSING FACTORS:

Lifestyle Factors Age: 78
Smoking Family History: DM, HPN, CVA
Alcohol
Diet: chicharon, sisig, lechon

Medical Conditions
High Blood Pressure

Lab Results
CXR: Cardiomegaly
Low HDL cholesterol: 45.6 mg/dL
High LDL cholesterol: 113.5 mg/dL
High cholesterol levels: 181.5 mg/dL
Creatinine: 1.39 mg/dL
Blood Uric Acid: 9.29 mg/dL
*↑Creatinine level also indicates muscle damage
*↑Blood uric acid also suggests HPN and ♥ disease

Endothelial lining of arteries are

injured
↑ Permeability to Platelets, WBC & Fibrin
lipoproteins converge at the injured site

Lipoproteins accumulated
in the intima of arterial wall

Macrophages infiltrate the

area to ingest lipids and die

Formation of dead fatty core

Formation of fibrous cap over

dead fatty core (plaque)

Plaque protrudes in lumen of the

vessel

Narrowed blood vessel Plaque ruptures & causes thrombus

obstructs/impedes blood flow formation
(platelet aggregation + fibrin)
Occlusion of an artery
 ↓ Myocardial perfusion/
↓ Blood flow to
myocardium

Unstable Myocardial Ischemia

Angina

(+) Chest Pain

radiating to
the left arm
Partially Ischemic Cells 07/20/10 Totally Ischemic Cells

Inadequate Accumulation of Accumulation of No supply of O2

supply of O2 and waste products waste products and nutrients
nutrients
Anaerobic ↓ ATP Inflammatory Mediators No ATP
Metabolism production

Hypocontractile Noncontractile Loss of cell

Accumulation membrane
of lactate integrity

Inhibition of Inhibition of
Glycolysis Ion pumps Cell Rupture

Altered cell
membrane integrity

Ion Leak

Myocyte death/ Necrosis

07/20/10
↓ K: 3.4mmol/L Dizziness
↑ WBC: 15.5 x 109 /L Diaphoresis
Myocardial Infarction
↑Creatinine: 1.39 mg/dL N/V
↑Blood Uric Acid: 9.29 mg/dL SOB
CXR: Cardiomegaly Unrelieved Chest
♥ Enzymes level: Elevated Pain
Non-ST ST Elevation 07/20/10
Elevation MI
♥ Monitoring: Non-ST
MI (STEMI)
Elevation
(NSTEMI)