SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY

for ACUTE CORONARY SYNDROME

NON-ST ELEVATION MYOCARDIAL INFACTION (ACS—NSTEMI)

PRECIPITATING FACTORS: PREDISPOSING FACTORS:

 Lifestyle Factors Age: 78
Smoking
Family History: DM, HPN, CVA
Alcohol
Diet: chicharon, sisig, lechon

 Medical Conditions
High Blood Pressure

 Lab Results
CXR: Cardiomegaly
Low HDL cholesterol: 45.6 mg/dL
High LDL cholesterol: 113.5 mg/dL
High cholesterol levels: 181.5 mg/dL
Creatinine: 1.39 mg/dL
Blood Uric Acid: 9.29 mg/dL
*Creatinine level also indicates muscle damage
*Blood uric acid also suggests HPN and  disease

Endothelial lining of arteries are injured

 Permeability to lipoproteins Platelets, WBC & Fibrin converge

at the injured site

Lipoproteins accumulated in the

intima of arterial wall

Macrophages infiltrate the area to

ingest lipids and die

Formation of dead fatty core

Formation of fibrous cap over dead

fatty core (plaque)

Plaque protrudes in lumen of the vessel

Narrowed blood vessel Plaque ruptures & causes thrombus formation

obstructs/impedes blood flow (platelet aggregation + fibrin)

Occlusion of an artery
↓ Myocardial perfusion/
↓ Blood flow to myocardium
(+) Chest Pain
radiating to the Loss of cell
Accumulation
Inadequate
Inhibition
Anaerobic supply
ofof of Inhibition
Altered
Accumulation
cell
of Ion
membrane
of left arm Accumulation of membrane
No integrity
supply of O2 and
Unstable
Metabolism
O Angina ↓ ATP
Ion
Hypocontractile
Leak
Partially Ischemicwaste
Glycolysis
2lactate
and nutrients production
Cells
pumps
integrity
products Myocardial Ischemia
07/20/10 Noncontractile Cell
No
Totally Ischemic Cells
waste products Rupture
ATP
nutrients
 Inflammatory Mediators

Myocyte death/ Necrosis

07/20/10
↓ K: 3.4mmol/L Dizziness
 WBC: 15.5 x 109 /L Diaphoresis
Creatinine: 1.39 mg/dL Myocardial Infarction
N/V
Blood Uric Acid: 9.29 mg/dL SOB
CXR: Cardiomegaly Unrelieved Chest Pain
 Enzymes level: Elevated 07/20/10
Non-ST ST Elevation MI
Elevation MI (STEMI)
 Monitoring: Non-ST Elevation
(NSTEMI)