3.1 Acute Coronary Syndromes (ACS)

Acute Coronary Syndromes (ACS)

Learning Outcomes

  • Describe the spectrum of ischaemic heart disease and compare and contrast chronic stable angina with the acute coronary syndromes
  • Explain the pathophysiology of the acute coronary syndromes
  • List the diagnostic criteria including ECG changes and troponins
  • Describe the initial management of acute chest pain (suspected ACS)
  • Define ST-segment Elevation Myocardial Infarction (STEMI) and describe the options for its initial (acute) treatment and long-term treatment
  • Define Non-ST-segment Elevation Acute Coronary Syndromes (NSTACS) and describe the options for the initial (acute) treatment and long-term treatment
  • Describe the pharmacology of the antiplatelet drugs used as part of the treatment protocols discussed.

Introduction to ACS

 

Ischaemic heart disease (IHD) is an umbrella term that includes a spectrum of disorders ranging from chronic stable angina through to unstable angina and myocardial infarctions (also known as heart attacks).

Patients with stable angina have chronic, stable symptoms.  In contrast, the acute coronary syndromes are situations whereby there are new or worsening symptoms associated with a sudden obstruction of coronary blood flow.

The acute coronary syndromes comprise of the following:

  • STEMI (ST-segment Elevation Myocardial Infarction)
  • NSTEACS (Non-ST segment Elevation Acute Coronary Syndromes) which is further subclassified into:
    • Unstable angina
    • NSTEMI (Non-ST-segment Elevation Myocardial Infarction)

It is also important to remember that the IHD spectrum can be progressive. For example, unstable angina can progress to a NSTEMI which can progress suddenly to a STEMI.

All of the diagnoses summarised above involve some degree of myocardial ischaemia. It is the extent and severity of the ischaemia that differs. As we progress to the right of the diagram, the ischaemia becomes more severe and lasts longer. When the ischaemia is severe and persistent enough to cause permanent damage to the myocardium, the result is a myocardial infarction of some type (NSTEMI or STEMI & we’ll discuss the differences later in this module). Such major cardiovascular events can result in cardiac arrest and death. If the person does survive, they may be left with impaired heart function, for example a diagnosis of heart failure and/or a dysrhythmia.

🎞️ Video 1: Watch the following video, “What is a heart attack?” ⏲️1:51 mins

🎞️ Video 2: Watch the following lecture video, “ACS Part 1″ ⏲️13:42 mins

License

PC3300 - Applied Therapeutics and Pharmacy Practice 3 Copyright © by JCU Pharmacy. All Rights Reserved.