ANMF’s Continuing Education: acute coronary syndromes

By ANMF Education Team|
2019-03-18T13:48:54+00:00
March 18th, 2019|

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Cardiovascular disease (CVD) is a major cause of death in Australia, with 45,053 deaths attributed to CVD in Australia in 2014. Cardiovascular disease kills one Australian every 12 minutes. (1)


Cardiovascular disease is one of Australia’s largest health problems. Despite improvements over the last few decades, it remains one of the biggest burdens on our economy. (1)

It is estimated over 400,000 Australians have had a heart attack at some time in their lives.

Each year, around 54,000 Australians suffer a heart attack. This equates to one heart attack every nine minutes. Heart attack claimed 8,623 lives in 2014, or on average, 24 each day. (1)

The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischaemia and covers the spectrum of clinical conditions ranging from unstable angina (UA) to non-ST-segment elevation myocardial infarction (NSTEMI) to ST-segment elevation myocardial infarction (STEMI). (3)

Cardioavascular disease refers collectively to coronary heart disease, stroke and other vascular disease including peripheral arterial disease and renovascular disease. (2)

In Australia 64% of the adult population have three or more modifiable risks factors. (2)

Modifiable risk factors

  • Smoking
  • Blood pressure
  • Serum lipids
  • Waist circumference and BMI
  • Nutrition
  • Physical activity level
  • Alcohol intake

 There are also non-modifiable risk factors such as:

  • Age (older than 45 for men and 55 for women)
  • Gender
  • Family history of premature cardiovascular disease (CVD)
  • Social history including cultural identity, ethnicity, socioeconomic status and mental health.
  • For women, a history of high blood pressure, preeclampsia or diabetes during pregnancy. (2)

Assessment of CVD risk on the basis of the combined effect of multiple risk factors (absolute CVD risk) is more accurate than the use of individual risk factors.

As CVD is largely preventable, an approach focusing on comprehensive risk assessment will enable effective management of identified modifiable risk factors through lifestyle changes and, where needed, pharmacological therapy. (2)

Absolute risk is the numerical probability of a CVD event occurring within five years, expressed as a percentage, eg. if a persons risk is 15% then you can inform them that 15 out of every 100 people are likely to have a CVD event within the next five years. (2)

Patients with suspected ACS must be evaluated rapidly to identify patients with life-threatening non-ACS causes for their acute presentation, quantify risk for ACS and promptly institute appropriate management. (1)

Typical angina symptoms, such as a substernal pressure–like chest pain with radiation to the jaw or left arm may not be present. Less typical symptoms, such as sharp chest pain, dyspnoea, diaphoresis, back pain, neck pain, nausea, fatigue, and palpitations may be manifestations of myocardial ischemia. (16)

One-third of patients with chest pain with known coronary disease, negative ECG, and biomarkers subsequently have adverse cardiac events. Less typical symptoms are more prevalent in women. In addition, symptoms suggestive of angina may in fact be due to other causes. (4)

Diabetics and older adults may also present with atypical symptoms including denial of pain (possibly due to decreased pain sensitivity).

Patients undergoing surgery have been found to be at risk of experiencing a myocardial ischaemic event during and after surgery (due to decreased BP, possible blood loss, effects of anaesthetic drugs). (5)

    • Take special care to assess these groups more thoroughly.

References:

  1. Heart Foundation, heartfoundation.org.au sourced December 2016 (Australia and NZ) Heart Foundation – Acute Coronary Syndromes information
  2. Heart Foundation, heartfoundation.org.au sourced December 2016 (Australia and NZ) https://www.heartfoundation.org.au/for-professionals/clinical-information/absolute-risk
  3. NCBI Resources: Acute Coronary Syndromes: Diagnosis and Management, Part I; Amit Kumar, MD and Christopher P. Cannon, MD; Mayo Clin Proc. 2009 Oct; 84(10): 917–938. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755812/
  4. Medscape; Acute Coronary Syndrome; author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD http://emedicine.medscape.com/article/1910735-overview#aw2aab6b2b4; sourced December 2016
  5. Nursing Times – http://www.nursingtimes.net/nursing-practice-clinical-research/identifying-and-managing-acute-coronary-syndrome/203389.article& Managing ACS 2006; Accessed December 2016

Reading the complete tutorial will give you five hours of Continuing Professional Development (CPD) hours. It covers ACS risks in detail, pathophysiology, presentation and diagnosis, nursing role, specific ACS disorders, management, complications of acute MI, education and rehabilitation.

To access the course go to the ANMF’s Continuing Professional Education (CPE) website or follow this link

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