Chest Pain Accreditation ACS Education

Chest Pain Accreditation ACS Education

Objectives Recognize the Typical and Atypical Signs and Symptoms of ACS Recognize Gender and Age Differences of ACS Recognize the Risk Factors of ACS Understand Early Heart Attack Care

Acute Coronary Syndrome

Acute Coronary Syndrome Any condition characterized by signs and symptoms of sudden myocardial ischemiaa sudden reduction in blood flow to the heart. The term ACS was developed to more clearly reflect the disease progression associated with myocardial ischemia.

Acute Coronary Syndrome Unstable Angina NSTEMI STEMI Non occlusive Thrombus Non Specific ECG Normal cardiac Enzymes Occluding thrombus Sufficient to cause Tissue damage & Mild myocardial Necrosis ST depression +/- T wave inversion On ECG Elevated ISOS Complete Thrombus Occlusion ST elevation on ECG or new LBBB Elevated ISOS More severe symptoms

Heart Disease Statistics

Statistics CVD is the leading cause of death in the United States An estimated 82.6 million American Adults (1 in 3) have one or more types of CVD 1 of every 2.9 deaths are related to CVD resulting in 1 death every 25 seconds CVD annual cost is $300 million dollars in the United States

Statistics 785,000 Americans will have a new coronary attack and about 470,000 will have a recurrent attack this year Average age of 1 st heart attack is 64.5 for men and 70.3 for women The estimated average number of years of life lost due to a heart attack is 15 90% of CVD patients have at least one of the major risk factors 25% of CVD patients are not receiving guidelinerecommended care

Statistics: Gender Differences CVD claims the lives of more women than men Based on 2006 mortality, 432,709 women died from CVD or 1 death per minute and is the leading cause of death for women. CVD rates in women after menopause are 2-3 times those of women the same age before menopause. Women are less likely to receive guideline-based care for CVD which increases their mortality Women are more likely to die from their heart attacks than men

Signs and Symptoms of ACS

Chest pain Jaw pain Signs and Symptoms Shortness of breath Sweating Nausea Lightheadedness Typical Pain/numbness radiating to the left arm Palpitations

Dizziness Weakness Back pain Neck pain Shoulder pain Abdominal pain Signs and Symptoms Atypical

Signs and Symptoms Women Shortness of breath Fatigue Lethargy Indigestion/nausea Anxiety Pain in back or left side of chest May report as numb, burning, or stabbing Palpitations Numbness in hands Sleep disturbances

Comparison of Symptoms Based on Atypical MI Symptoms in Women Gender Symptoms Present in both Genders Typical MI Symptoms in Men Absence of CP or vague chest discomfort Diaphoresis Chest pain No radiation of pain Shortness of breath Jaw pain Back pain Fatigue Pain b/w shoulder blades Heaviness in arms Weakness Shoulder pain Light headedness Epigastric burning Nausea Vomiting Feeling flushed Arm pain Neck pain Headache Indigestion Palpitations cough

Signs and Symptoms Diabetics Atypical symptoms or no chest pain Unexplained dyspnea Nausea Weakness Sweating

Signs and Symptoms Elderly Unexplained dyspnea Chest pain Syncope Unexplained confusion Mental status changes

Risk Factors

Risk Factors Non Modifiable Age Gender Family History Ethnicity or Race Known Coronary Artery Disease Prior CVA

Risk Factors Modifiable Diabetes Mellitus Smoking Hypertension Elevated Cholesterol Obesity/Metabolic Syndrome Sedentary lifestyle Stress

Metabolic Syndrome Indicators Abdominal Obesity: Waist Circumference: >40 in males >35 in females Elevated Triglycerides: >150 mg/dl Decreased HDL: Elevated BP: <40 mg/dl males <50 mg/dl females >130/85 mmhg Elevated Fasting Glucose: >100 mg/dl

Early Heart Attack Care Prevent the Heart Attack before it happens

What is Early Heart Attack Care? Early Heart Attack Care or EHAC is an effort to promote to the public that early signs of heart attack or warning signs occur in half of the patients who later experience a heart attack. Prompt recognition of these early warning signs can prevent a major cardiac event from occurring by teaching people to seek treatment as soon as they experience the symptoms.

Signs and Symptoms Prodromal/EHAC Non Specific symptoms Weakness/fatigue Clammy/sweaty Dizziness/nervous Shortness of breath Neck/back/jaw pain Elbow pain Feeling of doom Specific Symptoms Chest discomfort Chest pressure Chest ache Chest burning Chest fullness Symptoms usually occur within 24 hours before the acute attack, but could begin up to three weeks before.

Heart Attack Recognition Many patients with heart attacks are not getting the care that they need and require for their cardiac event This is due to the fact that most people delay seeking treatment when their symptoms begin, or don t recognize the symptoms.

Why Do People Delay? They don't take their symptoms seriously They don t have time to be sick They are embarrassed or don t want to cause a fuss They brush it off as heartburn and take medicine They feel too healthy and strong to be sick They wait for symptoms to go away

What Should You Do? If you encounter someone who has any of the early symptoms of heart attack: Suggest they seek treatment Call 9-1-1 Call family members to help Be persistent and patient and continue to encourage them to seek treatment If all else fails, take charge and get them to medical treatment

EHAC is Listening to your heart and recognizing the symptoms Calling 9-1-1 for early, immediate treatment EHAC is knowing the subtle signs and acting on them before irreversible damage occurs

References http://www.somc.org/heart/assets/ehac.ppt http://www.deputyheartattack.org/about.html http://journals.lww.com/critpathcardio/fulltext/2 010/09000/Society_of_Chest_Pain_Centers_Earl y_heart_attack.13.aspx American Journal of Nursing;Acute Coronary Syndrome, Kristin J. Overbaugh, MSN, RN, APRN-BC. May 2009, Vol. 109, No.5. Clinical Dimension; Myocardial Infarction in Women, S. Zbierajewski-Eischeid, RN MS, S. Loeb, PhD, RN. Jan/Feb 2009.

References British Journal of Healthcare Assistants; Understanding Acute Coronary Syndrome. Chris Mulryan. August 2010, Vol 4, No. 8. ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infraction.