Acute coronary syndromes

This chapter aims to outline the pathophysiology, methods for rapid diagnosis, and appropriate clinical management of acute coronary syndromes (ACS) so that it that may be applied within any area and at any point in the patient’s journey. The term ACS refers to a clinical spectrum of the same disease process, and includes unstable angina to non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI). The common underlying cause results in the formation of a platelet-rich thrombus and reduced coronary arterial blood flow, which either partially or completely occludes the artery. When complete occlusion of a coronary artery occurs (STEMI) limitation of the infarct size is vital and thus rapid initiation of treatment is essential to obtain the greatest benefit. The development of services such as pre-hospital thrombolysis, direct delivery of patients from the ambulance to the catheter laboratory, and ↑ numbers of 24h 1° percutaneous coronary intervention (PPCI) facilities available (Heart Attack Centres) have been important government initiatives that have been implemented to manage heart disease. Treatment for this group of patients may be initiated and then continued across a variety of areas which include the pre-hospital/community setting, emergency department, Coronary Care Unit, cardiac catheter laboratory, general ward, and chest pain unit. Nurses will encounter patients with both ST-segment elevation ACS and non-ST-segment elevation ACS at various points in their journey, thus clear and effective communication between healthcare providers across these different areas is imperative.