Acute Coronary Syndromes, Lecture notes of Korean

Download Acute Coronary Syndromes and more Lecture notes Korean in PDF only on Docsity! Acute Coronary Syndromes: Education for patients Hani Kozman, MD, FACC Director, Cardiac Catheterization Laboratory Upstate University Hospital Acute Coronary Syndromes •  Also known as ACS. •  Due to an enlarging clot in a coronary artery which can cause chest pain and damage to the heart muscle. •  When damage occurs to the heart muscle, a myocardial infarction occurs – most people know this as a “heart attack”. Cholesterol build up in the coronaries is known to start as early as age 17 as found on autopsies of Korean War soldiers. Over time, the cholesterol plaque can get so large that it ruptures. When the cholesterol enters the blood stream, a clot forms, causing diminished blood flow to the heart muscle. This lack of blood flow causes chest pain and damage to the heart muscle. If the artery doesn’t block completely with clot, damage may not occur to the heart muscle. The chest pain would then be called unstable angina. Clot and If the artery does not block completely, less damage usually occurs to the heart muscle than with complete blockage. There are less obvious changes on the electrocardiogram (ECG) as well. Acute Coronary Syndromes •  The chest pain associated with acute coronary syndromes is usually: – Severe, in the middle of the chest. – Often described as crushing or pressure. – Can go into jaw, back, left arm. – Can be associated with nausea, vomiting, shortness of breath, dizziness, passing out. •  The chest pain may not be there and you may only have the other associated symptoms which often happens in the elderly and women. Acute Coronary Syndromes •  You should go to the hospital or call 911 if you have chest pain lasting more than 30 minutes and any of the other features described in the previous 2 slides. •  Don’t try to tough out severe chest pain at home. The longer you stay home with a heart attack, the more damage occurs, the less chance you have of surviving it. Acute Coronary Syndromes •  What you can do while waiting for ambulance: – Chew and swallow an aspirin. – Take a nitroglycerin under the tongue if you have it. – Lie down on chair, sofa. Cardiac catheterization involves passing a thin tube from the leg or arm to the heart. The skin is numbed before the tube is inserted. There are no nerves in the blood vessels, so you won’t feel the tube going up. Dye is injected into the coronary arteries 7a & | Coronary artery blockage site X-ray image The site of obstruction is identified with dye injection.  This is how it looks with the heart beating. oe —_____ —  line Contrast oy “2 M ry ¥ 4 Contrast Boas | D.. es ae 1 EP eatin t we ects a esol by Erich) e 4 a Balloon -¥ Guide -* : Det oe f aay ' Guidewire Indeflator This is the set-up for performing the procedure. A stent is then placed inside the artery which is a metal scaffold to hold the artery open because the artery has a tendency to recoil back on itself. Stents are really small. Occasionally for an acute coronary syndrome, coronary bypass surgery is required. This usually happens when multiple blockages are found in the coronary arteries or the position of the blockage would be too risky to fix with a stent. Surgeons use veins from the legs or arteries from the chest wall to “bypass” all the blockages. Acute Coronary Syndromes •  The average patient remains in the hospital for 1-2 days after stent placement or 5-7 days after bypass surgery. •  When you get home it is important to: –  Take it easy for a week or two (longer after bypass surgery) – particularly no heavy lifting > 25 pounds. –  Take your medications as prescribed by your doctor – particularly the Plavix or similar blood-thinning drug. Stopping this drug suddenly after a stent without permission from your cardiologist may result in a more serious heart attack than the first time around. –  Stop smoking. –  Lose weight or at least try to follow a low-fat, low calorie diet. –  Stay active, 30 minutes of walking per day can make an enormous difference. Consider joining a cardiac rehabilitation program.