急性冠状动脉症候群.PPTVIP

Chang Gung University of Science and Technology Department of Nursing Tracy Hsu Acute C Syndrome (ACS) * Tracy Tracy * Definition is characterized by the presence of atherosclerosis in the epicardial coronary arteries. Atherosclerotic plaques, the hallmark of atherosclerosis, progressively narrow the coronary artery lumen and impair antegrade myocardial blood flow. The reduction in coronary artery flow may be symptomaticor asymptomatic, occur with exertion or at rest, and culminate in a myocardial infarction, depending on obstruction severity and the rapidity of development. Tracy * Prevalence (1/2) Cardiovascular disease (CVD) remains the leading cause of mortality in the United States in men and women of every major ethnic group. It accounts for nearly 1.4 million deaths per year as of 2002 and was responsible for one in almost three deaths in the United States in 2003. Approximately 13 million individuals have a history of coronary artery disease and 7.2 million have suffered a myocardial infarction. Tracy * Prevalence (2/2) Almost 2500 Americans die of CVD each day, an average of one death every 35 seconds. CVD claims more lives each year than the next four leading causes of death combined—cancer, chronic lower respiratory diseases, accidents, and diabetes mellitus. (American Heart Association and American Stroke Association, 2006) Tracy * Coronary artery disease Chronic stable angina Acute coronary syndrome 1) Unstable angina 2) Non-ST elevation MI (NSTEMI) 3) ST elevation MI (STEMI) 4) Sudden cardiac death Tracy * 致病機轉 Coronary atherosclerosis (粥樣硬化) Atherosclerotic plaque rupture—main cause of AMI Coronary vasospasm-variant angina, Prinzmetal angina Coronary embolism （栓塞） Tracy * 病理機轉 冠狀動脈之不穩定動脈粥狀硬化發生破裂 血小板活化及黏著 Fibrin clot 形成 冠狀動脈血栓形成 Tracy * Tracy * symptoms signs Chest pain/ tightness with or without radiation pallor, cold sweating, nausea, vomiting Palpitations( freq. VPC’s) Dyspnea , SOB Syncope (VT/Vf) ,hypotension (impending cardiogenic sh