PATHOPHYSIOLOGY

A.  Anatomy & Physiology    

The heart receives its own supply of

blood from the coronary arteries. Two
major coronary arteries branch off
from the aorta near the point where
the aorta and the left ventricle meet.
These arteries and their branches
supply all parts of the heart muscle
with blood.
The Coronary Arteries are the blood
vessels that supply blood to your
heart. They branch off of the aorta at
its base. The right coronary artery, the
left main coronary, the left anterior
descending, and the left circumflex
artery, are the four major coronary
arteries. Blockage of these arteries is a
common cause of angina, heart
disease, heart attacks and heart
failure.

Left Main Coronary Artery (also called the left main trunk)
The left main coronary artery branches into:
 Circumflex artery
 Left Anterior Descending artery (LAD)
The left coronary arteries supply:
 Circumflex artery - supplies blood to the left atrium, side and back of the left ventricle
 Left Anterior Descending artery (LAD) - supplies the front and bottom of the left
ventricle and the front of the septum
Right Coronary Artery (RCA)
The right coronary artery branches into:
 Right marginal artery
 Posterior descending artery
The right coronary artery supplies:
 Right atrium
 Right ventricle
 Bottom portion of both ventricles and back of the septum
The main portion of the right coronary artery provides blood to the right side of the heart, which
pumps blood to the lungs. The rest of the right coronary artery and its main branch, the posterior
descending artery, together with the branches of the circumflex artery, run across the surface of
the heart's underside, supplying the bottom portion of the left ventricle and back of the septum.

B.  Overview of the Disease

Acute coronary syndrome is a term used to describe a range of conditions associated with
sudden, reduced blood flow to the heart. One such condition is a heart attack (myocardial
infarction) — when cell death results in damaged or destroyed heart tissue. Even when acute
coronary syndrome causes no cell death, the reduced blood flow changes how your heart works
and is a sign of a high risk of heart attack. Acute coronary syndrome often causes severe chest
pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals
of treatment include improving blood flow, treating complications and preventing future
problems.

Symptoms
The signs and symptoms of acute coronary syndrome usually begin abruptly. They include:

 Chest pain (angina) or discomfort, often described as aching, pressure, tightness or

burning
 Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
 Nausea or vomiting
 Indigestion
 Shortness of breath (dyspnea)
 Sudden, heavy sweating (diaphoresis)
 Lightheadedness, dizziness or fainting
 Unusual or unexplained fatigue
 Feeling restless or apprehensive

Chest pain or discomfort is the most common symptom. However, signs and symptoms may vary
significantly depending on your age, sex and other medical conditions. You're more likely to
have signs and symptoms without chest pain or discomfort if you're a woman, older adult or have
diabetes.
C.  Contextual mapping/ Schematic Diagram

ACUTE CORONARY SYNDROME

ETIOLOGY
Is a manifestation of Coronary Heart Disease and usually a result
of plaque disruption in coronary arteries (atherosclerosis)

PREDISPOSING FACTORS

MODIFIABLE NON MODIFIABLE

 Obesity  55 years old: older adults typically
 Hypertension have a higher risk for ACS
 Diabetes  Family history of diabetes,
 Lifestyle (History of smoking) hypertension and cardiovascular
 Physical Inactivity disease
 Diet  Sex: Female

DISEASE PROCESS

Plaque disruption or erosion

Thrombus formation with or without embolisation

Acute Cardiac Ischaemia

No ST segment elevation

Unstable angina
 CLINICAL MANIFESTATIONS DIAGNOSTIC TEST PATIENT MANIFESTATIONS

 Pain or discomfort in one or IMAGING

both arms, TEST:  Shortness of breath
the jaw, neck, back or stomach.  Pain radiating to the left jaw associated with
 Body Weight  12LECG
Nausea and left arm numbness.
 Edema  Top I quanti
 Cool and Clammy extremities.
 Cranial CT Scan
 2Decho with doppler studies

OTHER TESTS:

 Urinalysis
 HbA1C
 FBS, Lipid profile
 SARS-2CoV RTPCR

MANAGEMENT

NURSING INTERVENTION
MEDICAL
SURGICAL Reinforce health teachings on:
 Thrombolytics (clot INTERVENTION
busters) Reinforce health teachings on:  Low salt, low fat, high
 Nitroglycerin fiber diet
 Antiplatelet drugs  Angioplasty and  Medication compliance
 Beta blockers stenting  Post-op activities
 ACE inhibitors  Coronary bypass a. Deep breathing
 ARBs surgery & coughing
 Statins b. Rest & activity
 Weight reduction