Acute Coronary Syndrome

Acute Coronary Syndrome
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January 2, 2011













Abstract

This paper will discuss acute coronary syndrome. It will explain what acute coronary syndrome, also referred to as ACS, and who is most likely to suffer from it. Causes and treatments as well as prevention and advances in medical research will also be covered.Acute coronary syndrome is a term given to a group of symptoms that have a high likelihood of being caused from acute myocardial ischemia. “Myocardial ischemia occurs when blood flow to your heart muscle is decreased by a partial or complete blockage of an artery that carries blood to your heart. The decrease in blood flow reduces your heart’s oxygensupply”. (Staff, 2010) When the oxygen supply to the heart is exceeded by its demand the patient may become symptomatic. Cardiac muscle needs an energy source to continue its contractions that pump blood to the body. This source of energy can be either aerobic or anaerobic. Aerobic respiration is the preferred method of energy production for the body including the heart. This type of respirationcan be accomplished when there is an adequate supply of oxygen perfusing the myocardial tissues. When the oxygen supply becomes is too low the heart will begin using anaerobic respiration for its energy source. This is accomplished through the breakdown of glucose. Much less energy is produced and there are byproducts such as lactic acid that are produced and must be removed by the body. Thislactic acid may also contribute to the pain of ACS.
The hallmark sign of acute coronary syndrome is chest pain. This is typically substernal and will frequently radiate to the neck, left shoulder, and left arm. These signs and symptoms are different in everyone though. “Evidence exists that women more often have coronary events without typical symptoms, which might explain the frequentfailure to initially diagnose ACS in women”. (Drew Evan Fenton, 2010) Many people will have jaw pain, toothaches, or just assume that they ate something that didn’t agree with them. Still others don’t have any symptoms at all. An in depth patient history may give you the only clues available.
There are a few causes that can mimic the signs and symptoms of the chest pain of ACS. They caninclude gastrointestinal disease, dissecting aorta, and musculoskeletal injuries. It may even be something as simple as heartburn or gastroesophageal reflux disease; however chest pain should always be treated as if it were cardiac related until it can be proven otherwise.
To make a definitive determination as to whether a myocardial infarction has taken place or not there are different tests thatare completed. Usually the first one done is an electrocardiogram, also called an ECG or an EKG. This is a test that records the electrical activity of the heart. During and after an MI electricity is conducted through the heart differently than it normally is. The printout from the EKG machine will show these differences.
Blood is drawn and multiple lab tests may be done. Creatine kinase,or CK, and troponin are the two that are checked most often. “The total CK is a simple and inexpensive test that is readily available using many laboratory instruments. However, an elevation in total CK is not specific for myocardial injury, because most CK is located in skeletal muscle, and elevations are possible from a variety of non-cardiac conditions.” (Chattington P, 1994) The total CK canbe further broken down into three isoenzymes. They are CK-MM, CK-MB, and CK-BB. CK-MB is mostly found only in cardiac muscle while total CK levels are increased when there is skeletal muscle damage or heart muscle damage. CK–MB and total CK are usually tested together in people exhibiting chest pain to diagnose if they have had a heart attack. Since a high total CK could indicate damage to...