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Patients with acute coronary syndrome have some degree of coronary artery occlusion. The degree of
occlusion defines whether the acute coronary syndrome is: • unstable angina • non–ST segment
elevation MI (non-STEMI) • ST segment elevation MI (STEMI).The development of acute coronary
syndrome begins with a rupture or erosion of plaque, an unstable and lipid-rich substance. The rupture
results in platelet adhesions, fibrin clot formation, and thrombin activation.
What causes it
Patients with certain risk factors appear to face a greater likelihood of developing acute coronary
syndrome.
• diabetes
• hypertension
• obesity
• sedentary lifestyle
• menopause
• hyperlipoproteinemia
• smoking
• stress.
How it happens
Acute coronary syndrome most commonly results when a thrombus progresses and occludes blood
flow. (An early thrombus doesn’t necessarily block blood flow.) The effect is an imbalance in myocardial
oxygen supply and demand.
• If smaller vessels infarct, the patient is at higher risk for MI, which may progress to a non-STEMI.
Usually, only the innermost layer of the heart is damaged.
• STEMI results when reduced blood flow through one of the coronary arteries causes myocardial
ischemia, injury, and necrosis. The damage extends through all myocardial layers. What to look for A
patient with angina typically experiences:
• burning
• squeezing