Acute Coronary Syndrome

by Jo Anne Naylor RN, BSN CCU Educator

What is Acute Coronary Syndrome ? How can I look at an EKG and tell what part of the heart is affected ?

What do ICU RNs need to know ?

 Majority of mortality associated with ST Elevation Myocardial Infarction (STEMI).S. almost half will be fatal. resulting in decreased oxygen supply to the heart muscle.What is Acute Coronary Syndrome (ACS) ? Acute Coronary Syndrome is when occlusion of one or more of the coronary arteries occurs. Over 1 million people will have Myocardial Infarctions this year.  .  ACS is the largest cause of death in U. usually following plaque rupture.

prolonged hypotension. DM Blood loss due to GI Bleed. hypothermia. DIC. drug use (especially cocaine) . hyperthyroidism. HTN. surgery. ESRD. sustained tachycardia. trauma Patients on dialysis with AV Fistulas (↑ myocardial O2 demands) Decreased O2 saturations (particularly in COPD) Fever.Who is at risk for ACS?      Anyone with history of CAD.

Who is at risk for ACS? Conditions that may mimic ACS include:      Musculoskeletal chest pain Pericarditis (can have acute ST changes) Aortic dissection Central Nervous System Disease (may mimic MI by causing diffuse ST-T wave changes) Pancreatitis/Cholecystitis .

The Three I’s  Ischemia= ST depression or T-wave inversion Represents lack of oxygen to myocardial tissue .

significant when > 1 mm above the baseline of the segment in two or more leads .represents prolonged ischemia.The Three I’s  Injury = ST elevation -.

must be pathological to indicate MI .The Three I’s  Infarct = Q wave — represented by first negative deflection after P wave.

aVF = Inferior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 .What part of the heart is affected ?  II. III.

Inferior Wall MI .

III & aVF = Inferior Wall MI = Right Coronary Artery blockage .Based on the EKG. which vessel in the heart is blocked?  II.

V3. and V4 = Anterior Wall MI I aVR V1 V4 II III aVL aVF V2 V3 V5 V6 .Which part of the heart is affected ? • Leads V1. V2.

Anterior Wall MI .

Based on the EKG.V4 = Anterior Wall (Left Ventricle) = Left Anterior Descending Artery Blockage . which vessel in the heart is blocked?  V1 .

aVL.What part of the heart is affected ?  I. V5 and V6 Lateral wall of left ventricle I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 .

Lateral Wall MI .

Based on the EKG. V5 + V6 = Lateral Wall = Circumflex Artery Blockage . which vessel in the heart is blocked?  I. aVL.

What do ICU RNs need to know? You should do a 12-Lead EKG when:  A patient who has CAD risk factors complains of Chest Pain When you are analyzing your rhythm strip on the flowsheet. OR any arrhythmias or changes in rhythm If your patient who is intubated / sedated suddenly begins to have hemodynamic changes putting stress on the heart + lungs   . and you notice that it looks different from the previous shift.

What do ICU RNs need to know?        Unexplained tachycardia Tachypnea Sudden elevation in PA catheter #’s or ICP (unexplained) Nausea and/or diaphoresis that doesn’t make sense Pallor Symptoms of sudden heart failure (pulmonary edema/crackles) Unexplained restlessness/all of a sudden needs more sedation .

Summary After completing an EKG. look at each of the leads for ST segment changes  Remember the three I’s: Ischemia. and Infarct !!  Identify the section of the heart (and vessel supplying it) affected by the blockage according to the groups of leads changing in the EKG  Remember the symptoms that would prompt you to obtain an EKG!  . Injury.

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