INTRODUCTION DEFINITION Acute coronary syndrome is a term used for any condition brought on by sudden, reduced blood flow

to the heart. Acute coronary syndrome symptoms may include the type of chest pressure that you feel during a heart attack, or pressure in your chest while you're at rest or doing light physical activity (unstable angina). The first sign of acute coronary syndrome can be sudden stopping of your heart (cardiac arrest). Acute coronary syndrome is often diagnosed in an emergency room or hospital. Acute coronary syndrome usually occurs as a result of one of three problems:ST elevation myocardial infarction (30%), non ST elevation myocardial infarction (25%), or unstable angina (38%). NSTEMI also known as non-ST segment elevation myocardial infarction is one type of heart attack, which is defined as the development of heart muscle necrosis results from an acute interruption of blood supply to a part of the heart muscle that is demonstrated by an elevation of cardiac markers (CK-MB or Troponin) in the blood and the absence of persistent ST-segment elevation in electrocardiography. SIGNS AND SYMPTOMS The cardinal sign of decreased blood flow to the heart is chest pain experienced as tightness around the chest and radiating to the left arm and the left angle of the jaw. This may be associated with diaphoresis (sweating), nausea and vomiting, as well as shortness of breath. In many cases, the sensation is "atypical", with pain experienced in different ways or even being completely absent (which is more likely in female patients and those with diabetes). Some may report palpitations, anxiety or a sense of impending doom (angor animi) and a feeling of being acutely ill.The description of the chest discomfort as a pressure has little utility in aiding a diagnosis as it is not specific for ACS CAUSES Acute coronary syndrome is most often a complication of plaque buildup in the arteries in your heart (coronary atherosclerosis) These plaques, made up of fatty deposits, cause the arteries to narrow and make it more difficult for blood to flow through them. Eventually, this buildup means that your heart can't pump enough oxygen-rich blood to the rest of your body, causing chest pain (angina) or a heart attack. Most cases of acute coronary syndrome occur when the surface of the plaque buildup in your heart arteries ruptures and causes a blood clot to form. The combination of the plaque buildup and the blood clot dramatically limits the amount of blood flowing to your heart muscle. If the blood flow is severely limited, a heart attack will occur.

transient ST-segment elevation. TREATMENT AND MANAGEMENT Patients should be admitted immediately to hospital. and cardiospecific proteins troponin T and troponin I are rises in NSTEMI.     . or Twave inversion. Cardiac markers: Cardiospecific isoenzyme CK-MB (creatine kinase myocardial band). preeclampsia or diabetes during pregnancy DIAGNOSIS  Electrocardiography (ECG): Electrocardiography finding of NSTEMI is usually associated with ST-segment depression. (2) Inhaled oxygen therapy. Troponin T and troponin I start to rise at 4-6 hours and remain high for up to two weeks. a history of high blood pressure. Echocardiography: It is done for assessing ventricular function and for detecting important complications. Chest X-ray: Assess for signs of lung edema. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may elevate. For women. (3) Relief of pain by opiate analgegic: Intravenous morphine 10 mg or diamorphine 5 mg is usually used and may have to be repeated to relieve severe pain. preferably to a cardiac care unit because there is a significant risk of death.RISK FACTORS        Older age (older than 45 for men and older than 55 for women) High blood pressure High blood cholesterol Cigarette smoking Lack of physical activity Type 2 diabetes Family history of chest pain. CK-MB starts to rise at 4-6 hours and falls to normal within 48-72 hours. Full blood count: Elevation of WBC count is usual. (1) Bed rest with continuous monitoring by ECG. heart disease or stroke.

or rosuvastatin after NSTEMI. heart rate. enalapril. all patients should receive statin such as atovastatin. simvastatin. (10) Coronary angiography and revascularization: All patients with NSTEMI should be considered for early coronary angiography and revascularization. especially where they are at medium to high risk patients. either by PCI (percutaneous coronary intervention) or by CABG (coronary artery bypass grafting). (9) ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensive receptor blockers): An ACE inhibitor such as ramipril.(4) Antiplatelet therapy: Antiplatelet drugs prevent platelet aggregation within coronary artery. A 300 mg tablet of aspirin should be given orally as early as possible then 75 mg daily should be continued indefinitely if there are no side effects occur. (8) Statins: Irrespective of serum cholesterol level. and relive pain. . blood pressure and myocardial oxygen demand. (7) Nitrates: Nitrates act as a vasodilator and relief pain. (6) Beta-blockers: Beta-blockers reduce arrhythmias. captopril. and coronary angiography and revascularization reserved for those who fail to settle with medical treatment. or lisinopril is started 1 or 2 days after NSTEMI. and reduces the risk of thromboembolic complications. Early medical treatment is appropriate in low risk patients. (5) Anticoagulant therapy: Anticoagulant drugs prevent reinfarction.

Nueva Ecija Attending Physician: Dr. Josephine Tindungan Date Admitted: July 28.PATIENT’S PROFILE Name: FA B-day: March 09. 2013 Chief Complaint: Chest pain Final Diagnosis: Acute Coronary Syndrome Non ST Elevation Myocardial Infarction . 1944 Age: 69 Sex: Male Status: Married Address: Cuyapo.