1. Questions for Thelma McKenzie: 1.Should it be assumed that the learners know all of the terminology, or should a glossary be included for review? 2.What information is still needed or should be increased? 3.What information is not necessary? Please note that the design/layout is not a final, but merely a way to organize. The background, color, etc. is up for revision for the final design.

2. Acute Coronary Syndrome

3. Scene 1 Acute Coronary Syndrome (ACS)  Unstable angina  Non-ST elevation myocardial infarction (NSTE – ACS)  ST elevation myocardial infarction (STE – ACS)

4. Scene 2  The rupture creates inflammatory response including:  Platelet adhesion  Platelet aggregation  Thrombin formation

5. Scene 3 Elevated Cardiac Markers  Troponin  Creatinine Kinase – MB (CK-MB)

6. Scene 4 What do the symptoms of Acute Coronary Syndrome (ACS) include?  Pressure, squeezing, fullness or pain in center of chest that last for several minutes  Chest discomfort that spreads to jaw, neck, shoulders or arms  Chest discomfort that spreads into the back or between the shoulders

7. Scene 5 Other symptoms include:  Dizziness  Lightheadedness  Nausea  Sweating  Shortness of breath

8. Scene 6 Scenario:  49-year-old woman  Diaphoretic  Short of breath  Tired  Nauseated  Skin pallor

9. Scene 7 FACTS: 33% show no chest pain 40% of patients show Atypical chest pain  Diabetes  Hypertension  Heart failure  Prior stroke  Myocardial infarction (MI)

10. Scene 8

11. Scene 9

12. Review 1. What is ACS? 2. What are the three (3) clinical syndromes of coronary artery disease? 3. What is the most common cause of ACS? 4. What are the most commom atypical locations and symptoms of chest pain? 1. an occlusion involving one or more of the coronary arteries 2. unstable angina, non-ST elevation myocardial infarction (NSTE – ACS), ST elevation myocardial infarction (STE – ACS) 3. rupture of lipid rich plaque 4. See scenes 8 & 9

13. Scene 10 Acute Coronary Syndrome (ACS): In Women Initial warning signs include:  Nausea  Fatigue  Dizziness  Shortness of breath

14. Scene 10a Acute Coronary Syndrome (ACS): In Women As reported in the American Heart Journal: “Women have significantly more back pain, jaw pain, nausea, vomiting, dyspnea, indigestion, and palpitations than men. “

15. Scene 11 Acute Coronary Syndrome (ACS): In Women  Increased occurrence of radiating chest pain  right arm/shoulder  back of the neck  If hospitalized > 50 for MI – twice as likely to die in the hospital than men

16. Scene 12 Acute Coronary Syndrome (ACS): In Women As reported in the American Journal of Cardiology: “…short-term mortality rate is greater in women who have their first non-ST elevation myocardial infarction.”

17. Scene 13 Acute Coronary Syndrome (ACS): In Women According to the Journal of Pain and Symptom Management: “…women are less likely to describe their discomfort as pain but rather describe it as “chest discomfort,” with associated shortness of breath, nausea, or loss of appetite.”

18. Scene 14 Elderly, especially those > 75 exhibit other symptoms:  Syncope  Confusion  Stroke  Fatigue Note: 60% of MI patients are > 65

19. Scene 15 Acute Coronary Syndrome (ACS): In Elderly According to the American Journal of Geriatric Cardiology: “elderly patients lack anginal pain and have more palpitations, syncope, and dyspnea regardless of gender. Typically, chest pain presentation decreases with advanced age.”

20. Scene 15a Acute Coronary Syndrome (ACS): In Elderly According to the American Journal of Geriatric Cardiology:  14% of elderly men less than or equal to age 65  18% for those between 65 – 74  30% for those 75-years and older

21. Scene 15b Acute Coronary Syndrome (ACS): In Elderly According to the American Journal of Geriatric Cardiology:  19% of elderly women less than or equal to age 65  28% for those between 65 – 74  36% for those 75-years and older

22. Scene 17 If ACS is suspected: Initial Treatments:  Oxygen  Aspirin  Nitroglycerin  Morphine  12-lead EKG  Reperfusion (if indicated)